Abstract
Background
No work has been reported on the use of video websites to learn about deep vein thrombosis and the value of education using them. We examined the characteristics and scientific accuracy of videos related to deep vein thrombosis on YouTube.
Methods
YouTube was surveyed using no filter and the key words ‘deep vein thrombosis’ and ‘leg vein clot’ in June 2016. The videos evaluated were divided into three groups in terms of their scientific content, accuracy, and currency: useful, partly useful, and useless.
Results
Of the 1200 videos watched, 715 (59.58%) were excluded with the exclusion criteria. Although most of the videos uploaded (22.9%, n = 111) were created by physicians, the number of views for website-based videos was significantly higher (p = 0.002). When the uploaded videos were assessed in terms of their usefulness, videos from physicians and hospitals were statistically more useful than other videos (p < 0.001).
Conclusions
For videos created by medical professionals to be of higher quality, we believe they should be more up-to-date and comprehensive, and contain animations about treatment modalities and early diagnosis in particular.
Introduction
Venous thromboembolism is third only to myocardial infarction and stroke as a leading cause of cardiovascular death worldwide.1,2 In Europe, about 500,000 people lose their lives per year due to venous thromboembolism or some related disease. 3 Deep vein thrombosis (DVT) is a frequent issue at the clinic and its most dangerous resulting condition is acute pulmonary embolism. Venous thromboembolism leads to high rates of death and recurrence as well as serious sequelae and lower quality of life. DVT treatment is associated with high hospital costs and time off work, so the training of patients is of great significance in terms of prophylaxis and early diagnosis. 4
Today, many people prefer to use sources such as the internet, TV, and journals to gain information about important diseases such as DVT. With increased internet use worldwide, many people frequently refer to internet sources to gain information on their diseases through their smart phones. In this regard, YouTube has been a free and popular video-sharing site since 2005. 4 A survey of the literature for training or general information showed no reported study or work assessing the YouTube video-sharing site regarding vein thrombosis. Thus, we examined the scientific content of videos related to DVT on YouTube.
Materials and methods
YouTube was searched with no filter and using the key words ‘deep vein thrombosis’ and ‘leg vein clot’ in June 2016. The videos thus found were evaluated. When the search was conducted for each key word, the most recent 600 studies (30 pages, and 20 videos per page) were included in the study. Thus, 1200 videos were examined. Videos regarding alternative medical methods, containing promotional material and commercials, that were irrelevant, that were duplicates, and that were not English were excluded. Consequently, only 485 videos were included. The characteristics, broadcasting dates, contents, numbers of views, durations, and animation contents of the videos were assessed and recorded. Each video was watched by two independent vascular surgeons on the basis of their value to the public. The decision of a third vascular surgeon was accepted in cases of disagreement. The videos were examined in terms of general information, diagnosis, and treatment options, as well as their currency and accuracy. Videos meeting all three criteria were accepted as useful, those lacking one criterion were accepted as partly useful, and those lacking two or more criteria were deemed useless. Statistical analyses were conducted only on videos deemed and to be useful.
Statistical analysis
Shapiro–Wilk test was used for assessing whether the variables follow normal distribution or not. Continuous variables were presented as median (IQR: inter quartile range) values where categorical variables were reported as n (%). Number of the views of the videos was compared among sources that videos were uploaded by Kruskal–Wallis test. Post hoc comparisons were performed with the Mann–Whitney U-test with Bonferroni correction. Rate of the usefulness of the videos were compared among the sources by Fisher–Freeman–Halton test. For post hoc comparisons, chi-square test with Bonferroni correction was used. To determine whether there was a trend among the years according to the number of videos uploaded, chi-square trend test was applied. The agreement among the observers who rated the videos was examined by weighted Cohen’s kappa (κ) with linear weights. SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) was used for performing statistical analysis and the level of significance was set at α = 0.05.
Results
Reasons for excluding videos from analysis.
Characteristics of the videos included in the analysis.
Distribution of scores of the videos and download rates with respect to source of upload.
IQR: interquartile range.
p-value was calculated for the comparison of the ratio of usefulness of the videos uploaded by different sources.
p-value was calculated for the comparison of number of views of the videos uploaded by different sources.
An evaluation of the sources of videos showed that there was a difference in terms of the number of views (p = 0.002). Videos uploaded from the website were viewed significantly more often than those uploaded from TV show, physicians, and independent users (p = 0.003, 0.021, and 0.034, respectively). There were no statistically significant differences between these groups. The usefulness of videos also differed according to the source (p < 0.001), where those uploaded by physicians were rated higher than those from independent users, firms, websites, health services, and TV shows (p < 0.001, 0.018, < 0.001, 0.010, and 0.021, respectively). Videos from hospitals and from physicians were rated more highly than those from independent users, firms, websites, health services, and TV shows. There were no significant differences between the other groups.
Comparison of the numbers of views of the usefulness of videos according to years.
IQR: interquartile range. Statistical significance in bold.
Discussion
Many resources are used in health education today. The most frequently used are internet videos, and YouTube is the leading website for videos with more than 10,000 videos, more than 1,000,000,000 views, and longer than 70,000,000 viewing hours, as of March 2015. 5 How useful videos related to any given field are, and which sources have been used most, have been examined in many studies. Ching et al. 6 studied the effectiveness of websites about the treatment of varicose veins and determined that most videos were from hospitals. However, Gunes et al. 7 found that most were uploaded by professional health staff. Adhikari et al. 8 found that most videos about cervical cancer were uploaded by physicians. Serinken et al. 9 indicated that most videos on renal calculus were uploaded by physicians and academics. In our study, we found that most videos about DVT were from physicians.
However, the usefulness of these videos must also be discussed. As most of the videos were not prepared by physicians and some were intended for commercial purposes, it was clear that they did not contain sufficient information about the disease. Several other studies have assessed the usefulness of such videos. In Ching et al.’s study 6 on varicose veins, the most useful videos were from hospitals. In Gunes et al., 7 the most useful ones were from government/official institutions. We determined that videos by physicians and hospitals were most useful, consistent with much of the general literature.
The number of views also differed among sources. In Adhikari et al., 8 the most viewed videos about cervical cancer were uploaded by independent users; however, in Gunes et al., 7 the most viewed videos were uploaded by government/official institutions. In our study, videos uploaded from internet websites were the most viewed. Gunes et al. 7 reported that the number of useful videos about a topic tends to increase over time. In contrast, we found that the number of useful videos had recently declined. It should also be mentioned that the number of useful videos decreased at a higher rate than that of useless videos. Thus, it appears that physicians and hospitals producing useful videos should prepare videos that are more understandable, frequently updated, and that contain more animations.
Videos do not commonly mention updated treatment methods. Koller et al. 10 reported that information on the diagnosis and treatment of hip arthritis was far from adequate in videos. Fernandes et al. 11 studied new-generation oral anticoagulants for the medical treatment of venous thromboembolism and found that mechanical thrombolytic treatments and oral anticoagulants, except vitamin K, have taken their place in updated treatment guidelines. 12 These newer treatment modalities should be included in videos that provide information on DVT. In our study, however, more than half of the videos uploaded had only partly sufficient and accurate information regarding treatments for DVT, and viewers were largely informed only about conventional medical treatments such as the use of vitamin K antagonists and low-molecular-weight heparin combination treatments. Endovenous treatments, which are updated treatment methods, are given little attention in these videos.
Limitations
The content in internet media is ever-changing with respect to time and date of a search. This study was conducted via a search of the YouTube website using keywords determined a priority (deep vein thrombosis, leg vein clot) and included only items in the first 30 pages (20 videos/page). Additionally, videos were assigned to three groups as useful, partly useful, and not useful, instead of using a validated scoring system.
Conclusions
While YouTube contains some conflicts in terms of health information, it is an increasingly important source of information about healthcare matters. Regarding DVT, in which early diagnosis and treatment are important, it is of concern that the current videos do not represent a sufficient source of updated information. Those videos uploaded by healthcare professionals on YouTube are indicated by a sign may guide viewers to the more useful videos. However, we are of the opinion that for the uploaded videos to be of higher quality, healthcare professionals and governmental/official institution/associations should prepare videos that are updated frequently, are more comprehensive, and contain more animations and information about early diagnosis and treatment methods (and their potential complications).
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.