Instagram is a highly used interface on social media with 110 million users in the United States and over 1 billion users worldwide [1]. As social media platforms have evolved, consumers are increasingly utilizing Instagram to learn about their medical condition using hashtags. Hashtags are short phases preceded by ‘#’ on social media websites. The aim of this study was to examine the quality of pelvic organ prolapse (POP) posts on Instagram and to evaluate the understandability and actionability for its consumers.

Using the hashtag, ‘#PelvicOrganProlapse’ the first 105 Instagram posts that met inclusion criteria were analyzed. Posts were limited to the English-language and POP content. We used validated questionnaires, the DISCERN criteria and Patient Education Materials Assessment Tool for audiovisual (PEMAT), to assess the post [2]. DISCERN questionnaire consisted of 16 items that were answered as 1=no, 2, 3=partially, 4, or 5=yes, respectively. PEMAT evaluates the understandability and actionability of patient education resources using a questionnaire containing 17 items (13 on understandability and 4 on actionability) that receive a score of agree= 1, disagree= 0, or not applicable= N/A. Misinformation was examined, using a Likert scale ranging from no misinformation=1, some misinformation=3, to high misinformation= 5, comparing posts content to accepted POP management recommendations from educational literature and an International Urogynecological Association (IUGA) /International Continence Society (ICS) joint report guidelines, as the reference standard. Data was analyzed using STATA software to produce the descriptive statistics.

In total, 105 Instagram posts with a total of 8,859 likes were evaluated. Characteristics of Instagram pelvic organ prolapse posts are shown in Table 1. The most commonly published posts were by health and wellness groups (44%). Pelvic floor muscle training (PFMT) was the most frequently reported treatment option (59%), while surgical repair was reported in 11% of posts. Surgical repair was mentioned in 13% of posts by health and wellness groups. Twenty-two percent of posts discussed causes of POP and 36% of posts mentioned associated symptoms of POP. 

Posts with content that includes low quality or insufficient scientific validation are shown in Table 2. Seventy-six percent of posts were comprised of moderate to poor quality information, or an overall DISCERN score less than or equal to 3. Poor quality posts often failed to address risk of treatment, other available treatment options, and/or shared decision making with medical professionals. One-fourth of posts had commercial bias. Thirty-six percent of posts were given low PEMAT scores (a score below 75%) for understandability, while 69% of these posts had a low PEMAT score for actionability. One-fourth of PFMT posts had moderate to poor quality information, while over one-third of PFMT posts had commercial bias. Forty percent of PFMT posts contained low PEMAT scores (a score below 75%) for understandability, while 56% of these posts had a low PEMAT score for actionability.

Instagram contains POP posts lacking complete information which is crucial for users’ medical decisions. Forty-four percent of the posts were published by health and wellness groups, with most of these posts mentioning PFMT (64%) as a treatment option. Previously reported studies found 20.0% of women will have a lifetime risk of undergoing POP surgery by the age of 80; however, the readily available content on Instagram does not reflect these trends [3]. Only 13% of Instagram posts by health and wellness groups mentioned surgical repair. Despite the high prevalence and the increased risk of developing POP, many women continue to lack fundamental knowledge and awareness of this common gynecologic condition and the paucity of accurate information being disseminated on social media is not of much benefit to lay persons. Many users are encountering POP posts which encourages PFMT as a treatment modality without being aware that 33% of these posts contain biased content. 

Our study reported over three-fourths of posts lacked high quality information and a quarter of posts contained commercial bias, or promoted the use of certain products to rapidly alleviate aggravating POP symptoms. This is worrisome because information on social media is easily accessible, yet content is not validated and can negatively influence a patients’ decision-making. Furthermore, over 50% of both POP and PFMT posts were comprised of content with moderate to poor actionability, perturbing users as they attempt to navigate the often-mystifying medical field. These posts can accelerate confusion among patients and inhibit their ability to seek proper medical care, affecting their well-being.

Overall, Instagram posts contain limited content with poor quality information, which increasingly focuses on pelvic organ prolapse with pelvic floor muscle training . The absence of complete information on treatment modalities can limit unknowing users from alternative options, thus precluding their judgement.

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