Evaluating articles on the content and quality of YouTube videos regarding women’s health: a scoping review

Purpose This scoping review investigated the content and quality of YouTube videos on women’s health. Methods A literature search of the Cochrane Library, PubMed, Embase, CINAHL, ERIC, and RISS databases was performed using the keywords “(‘youtube’/exp OR youtube OR ‘social media’/exp OR ‘social media’ OR ((‘social’/exp OR social) AND (‘media’/exp OR media))) AND (‘female health care’ OR ((‘female’/exp OR female) AND (‘health’/exp OR health) AND (‘care’/exp OR care)))” from February 21 to 27, 2023. Peer-reviewed analytic studies in English or Korean that focused on women’s health using YouTube were included. Results The review identified 21 articles that covered various themes related to women’s health, such as breast cancer, urinary disease, sexual health, pelvic organ prolapse, the human papillomavirus vaccine, Papanikolaou smears, contraception, women’s health information during the coronavirus disease 2019 pandemic, obstetric epidural anesthesia, and placenta accreta. However, the overall quality of the content was low, inaccurate, unreliable, and misleading. Conclusion This scoping review demonstrated that YouTube videos on women’s health covered diverse topics, but the quality of the content needed improvement. More reliable and high-quality videos produced by academic institutes and healthcare professionals specializing in women’s health are needed for social media to be usable as a reliable source of women’s health information. The high number of views and shares received by the videos underscores the importance of providing accurate and reliable information on women’s health.


Introduction
Social media is a term that refers to websites and social network services that facilitate electronic communication and the exchange of information, ideas, and messages.Examples of social media platforms include YouTube, Twitter, Instagram, Facebook, and TikTok.Among these platforms, YouTube is a popular form of social media due to its ability to deliver information quickly and easily through video [1].Since anyone can upload videos to health information in face-to-face settings, most people still search for information on YouTube and other sources on the internet, which can significantly impact their decisions [2,3].
YouTube has become a popular source of health information because it contains a vast amount of information, and YouTube videos can be produced quickly and are easy to share [4].People often turn to YouTube for medical advice on disease diagnosis and treatment options, as well as for educational information on coping strategies as patients [5].
Women experience health problems and issues throughout their lives, regardless of their location or region.In both Eastern and Western cultures, women are often reluctant to disclose their health problems or seek treatment from obstetricians and gynecologists [6].As a result, women with health problems may turn to YouTube to obtain health information.However, given that anyone can post information on YouTube, it is crucial to perform reliability appraisals of health information [5].For this reason, we conducted a review of published papers to investigate the types of information related to women's health that YouTube viewers access and to evaluate the quality and reliability of the information presented.
A scoping review aims to identify the characteristics and objectives of a study by providing a preliminary assessment.One advantage of conducting a scoping review is that it offers an overview of the latest research, and the results can be rapidly integrated into policies [7].A disadvantage, however, is that bias may occur because the quality appraisal of research, typically employed in systematic reviews, is not required [7].To address this limitation, we incorporated quality appraisal into our study.
The objectives of conducting this scoping review were to examine YouTube-related papers concerning women's health, identify prevalent women's health-related themes, and evaluate the quality of the videos.Analyzing the themes and quality of women's health-related YouTube videos can offer evidence for their use as a women's health nursing intervention, as well as implications for women's health nursing practice and research.The overall goal of this study was to analyze the subjects and quality of women's health-related issues featured in YouTube videos.More specifically, this study aimed to examine the topics and content of YouTube videos, along with their effects and outcomes.

Study design
In this study, we carried out a scoping review of the literature to evaluate the content and quality of YouTube videos related to women's health.The thematic analysis phase followed the review methodology framework of Grant and Booth [7], as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) reporting guideline, which outlines the assessment criteria for an evidence-based systematic review [8].

Review process
The scoping review research process involved the following six steps: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the results [9].

• What is already known about this topic?
Social media videos on YouTube have several advantages, such as being visually appealing, easily accessible, widely popular, and containing various types of content.However, problems remain with accuracy, reliability, and trustworthiness.

• What this paper adds
This study provides insights into the quality and impact of YouTube videos on women's health.Although the videos cover various health problems that affect women, the overall quality and reliability of the information presented in these videos were found to be low.
• Implications for practice, education, and/or policy Healthcare professionals should create a variety of reliable and high-quality YouTube videos that offer useful and informative interventions for women's health.This should involve a process of verifying the reliability and quality of the information contained in these videos.

1) Identifying the research question
The research question of this study was defined as "What is the quality and content of YouTube videos related to women's health?. " 2) Identifying relevant studies The inclusion criteria for literature selection were as follows: ( The titles and abstracts of the remaining articles were thoroughly screened, and those unrelated to women's health using YouTube were eliminated.This process resulted in 21 articles, including two from the Cochrane Library, 16 from PubMed, none from Embase, two from CINAHL Complete, none from ERIC, and one from RISS.We also conducted a manual search through the reference lists of the articles and identified an additional four relevant articles.Two of these articles were included, bringing the total number of articles to 23.We read the full texts of all 23 articles and selected 21 articles for the final analysis, excluding one article that presented only a simple preference survey and another article that was related to nurses' health but not to women's health (Figure 1).

5) Collating, summarizing, and reporting the results
The researchers extracted data independently according to research objectives, produced case reports, and synthesized the data from 21 articles .The extracted data items were as follows: first author, publication year, country, content, theme, study design, subjects, number of subjects, evaluators, outcomes, measurement scales, effects, and conclusion.In cases where the extracted data differed between the researchers, the content was harmonized through a meeting.
Informative content related to incontinence was found in 47% of videos on that topic, while commercial content was present in 40.0%[12].Only 33.0% of videos about the HPV vaccine had a positive tone, whereas a higher percentage had a negative tone [13].No statistically significant difference was found between the video allocation group and the viewing group in terms of view count and sharing count for women's health-related videos [14].In addition, 34.5% of videos related to female physical examinations were found to be useful [15].Among the videos related to Pap smears, 62.0% had false information.In the videos related to women's health during COVID-19 pandemic [21], only 4% of the information was accurate despite 40% of the content being clear [16].There were no statistically significant differences in accuracy and satisfaction related to contraception between the YouTube and non-YouTube viewing groups [17].Videos related to breast cancer had low average content quality scores of 2.9 ± 1.0 and low accuracy of 5.3 ± 2.8 [18].Other studies also found that videos related to breast cancer had low average content quality scores of 26.70 ± 10.99 and low accuracy scores of 2.23 ± 0.97 [18].Videos related to incontinence showed low understandability (57.9 ± 19.8) and low actionability (44.7 ± 35.9) [20].Postpartum sexuality videos were deemed acceptable by 84% of healthcare professionals and 87% of patients [22].Inconti-nence-related videos had an average content quality score of 38.2 ± 11.5 [23].Only 4.3% of the respondents found videos related to breast cancer examinations to be very useful [24].A significant portion of epidural anesthesia videos, ranging from 42% to 49%, were deemed inappropriate for not adhering to the aseptic technique [25].Furthermore, 80% of the videos on arm exercise after breast cancer surgery were found to be useful, but 47.6% contained misleading information [26].Sexual education videos led to a 36.67-pointincrease in sexual knowledge scores, and significant increases in scores for sexual attitudes (t = -6.66,p < .01)and parent-child attachment (t = -4.40,p < .01)were observed [27].The videos related to pelvic organ prolapse were found to be useful by 73.3% of the respondents.However, the readability of the videos was rated slightly difficult (10.4 points) [28].The videos related to BRCA mutation testing produced by healthcare professionals had a higher number of viewers, with 71 viewers compared to 29 for videos produced by consumers [29].The quality of content for videos related to placenta accreta was found to be higher in those produced by professionals, with education quality rated at 82.6% and reliability at 26.2%, which were higher than for the videos produced by consumers [30].Videos related to female urethroplasty produced by universities or hospitals had higher levels of reliability and accuracy compared to those produced by urologists [32].In addition, the female urinary tract infection videos on YouTube had higher content quality and reliability, but more misleading information, than those on TikTok [31] (Table 2).

Discussion
This scoping review is a significant contribution as it examined studies that analyzed YouTube videos related to women's health, identified their content and themes, and analyzed their effects and outcomes.With more people turning to social media platforms for health information, especially during and after the recent pandemic, this review is important because it used analytical studies to evaluate the accuracy, reliability, and quality of women's health information posted on YouTube .The study highlights that videos on various themes related to women's health have been posted on YouTube, with breast cancer being the most prevalent and popular theme.There was a total of five studies [18,19,24,26,29] on videos related to breast cancer, including two [18,19] on breast cancer itself and one each on gene testing [29], cancer screening [24], and rehabilitation postoperation [26].The second most prevalent theme was female urinary diseases, which were covered in three studies [12,20,23], includ-  ing one on urethroplasty [32] and one on urinary tract infection [31].The third most prevalent theme was sex-related, with two studies [22,27]: one on postpartum sexuality [22] and the other on sex education for girls in upper elementary grades [27].This study sheds light on the wide range of women's health topics that are covered on YouTube, indicating significant public interest in these areas.However, the analyses suggest that gynecology diseases are the most frequently discussed topics, with a heavy focus on breast cancer and urinary disorders, while obstetrics-related videos tend to only cover epidural anesthesia [25] and placenta accreta [30].Thus, this study highlights the need for women's healthcare professionals to create more gynecology and obstetrics-related videos, which should undergo rigorous analysis and cover a broader range of themes related to women's health.
The study synthesized the results of previous studies to analyze the effects and outcomes of YouTube videos related to women's health.The overall quality of YouTube content was low, with low ratings for usefulness, accuracy, and reliability.The study also revealed that videos produced by healthcare professionals were generally of higher quality and contained less fake information than those produced by consumers [23].Videos produced by academic institutions were also found to have higher quality of content, reliability, and accuracy [32].Although there has been a strong demand for healthcare information since the COVID-19 pandemic, large amounts of unverified information have spread via the internet, and non-professional videos have potentially had adverse effects.Of the various resources on the internet, those with the most reliable and high-quality information are from research centers and professional societies [33].Therefore, this study emphasizes the importance of healthcare professionals producing and validating videos, with institutions being preferred producers [32].Compared to other social media platforms, such as TikTok, Facebook, and Instagram, YouTube was found to have higher quality and reliability of content, indicating that it can be an effective tool for disseminating information related to women's health [28], as long as accurate information is provided.
Although the quality of YouTube content related to women's health was generally low [12,18,19,21,25,30] and average level of quality [23], this study found some positive outcomes in the quality of video content.According to the DISCERN total score system, content quality was classified as excellent (63-75), good (51-62), average (39-50), poor (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), and very poor ( < 28).In a systematic review of web-based resources related to complementary and alternative therapy, the DISCERN score averaged 56.13 (standard deviation, 10.25) out of 75 points [34], which was higher than the results of this study.For instance, arm and shoulder exercises after breast cancer surgery posted on You-Tube were found to be useful in 80% of cases and considered to be valuable educational tools for preventing musculoskeletal complications due to their high quality and reliability [26].These findings suggest that YouTube videos can be a helpful tool for providing direct visual assistance and practical guidance, rather than just general knowledge about diseases and conditions.The COVID-19 pandemic has increased the demand for information on pregnancy [16], but the reliability of YouTube videos related to this topic was found to be low.This emphasizes the need for more reliable YouTube videos, especially for vulnerable populations such as pregnant women who may have difficulties obtaining information through face-to-face education during the pandemic [35].
Most YouTube videos related to women's health focus on changing knowledge rather than skills or attitudes .However, in videos that aim to teach techniques, the rate of adherence to aseptic technique was low, ranging from 42% to 47% [25].The reliability of the procedure was also found to be low, highlighting the need for accurate and reliable videos produced by healthcare professionals.In a study on postpartum sexuality, the experimental group that watched a YouTube video showed a more positive attitude toward sex and felt more comfortable discussing it than the control group that did not watch the video [22].While most videos have educational purposes to improve knowledge and skills, changing people's attitudes can also be a useful intervention technique on YouTube.For example, videos with a negative tone about HPV vaccination tend to receive more "likes," suggesting that viewers may be more drawn to negative aspects of a topic rather than positive ones [13].Therefore, it is important for both consumers and researchers to be aware of the socio-cultural prevalence of fake news and misleading information on women's health issues that lack scientific evidence [22].
This study has several limitations.First, there may be themes and effects related to YouTube videos on women's health that have not been identified since the analyses were conducted indirectly through studies that reviewed these videos.Furthermore, due to the constantly changing nature of YouTube, the results may not accurately reflect the current reality of women's health-related videos on the platform.Second, only videos produced in English, Korean, and Turkish were included in the analysis, so videos made in other languages were not represented.Third, content analytical and experimental studies were analyzed together, which could lead to problems with comparability.
Nonetheless, this study underscores the importance of producing more high-quality videos on a wider range of topics related to women's health, utilizing the benefits of prevalence and accessibility offered by YouTube.To ensure the reliability and quality of content, it is recommended that videos be produced by healthcare professionals and that institutions, rather than individuals.Even after the pandemic, YouTube videos are expected to continue to be an important educational resource, as they have become a critical source of information about women's health in a non-face-to-face society.

Figure 1 .
Figure 1.Flow diagram for the literature search.

Table 1 .
Content and themes of selected studies (N=21)