The Internet is the most readily accessible medium for patients to access information. YouTube is the second most popular website in the world behind Google and has a growing influence in the distribution of health information(1). The aim of this study was to assess the content and quality of information available to patients on YouTube when searching ‘erectile dysfunction’.

Two independent reviewers who are both medical practitioners, searched ‘erectile dysfunction’ on YouTube in April 2021 and evaluated the first 50 videos listed, reflecting the content patients are most likely to view. No search restrictions were applied, including language. Information related to views, video producer, quality of content, understandability and actionability for viewers was assessed. The videos were assessed using the validated Patient Education Materials Assessment Tool (PEMAT)(2) and the DISCERN criteria(3). PEMAT is a tool which assesses the understandability and actionability of audio-visual content. It consists of assessment of thirteen areas of understandability and four areas of actionability. For each area, assessors grade the content on whether or not it reflects the criteria as either ‘Agree’, ‘Disagree’ or ‘Not Applicable’. ‘Agree’ is chosen if the content assessed occurs in 80-100% of the material presented.  The total score is then calculated (‘Agree’ = 1 point, ‘Disagree’ = 0 points) and a percentage score for understandability and actionability generated. The DISCERN criteria assesses the quality of consumer health information, focusing on the sourcing, bias and reliability of information provided. The content is assessed across 16 areas, rated overall from a score of 1 (serious or extensive shortcomings) to 5 (minimal bias). Before assessing content, both reviewers had to familiarise themselves with both the PEMAT and DISCERN tools. Any conflicts in the grading of material were discussed between reviewers and a decision made. Statistical analysis was performed using R software version 3.6.3 to undertake univariate analysis with PEMAT and DISCERN scores. A p value of < 0.05 was deemed significant.

The first 50 videos listed by YouTube when searching ‘erectile dysfunction’ were produced between December 2011 to February 2021. 90% of content provided medical information, though only 56% had been produced by recognised medical institutions. Only 4% of content provided an insight into a patient’s personal experience with the condition. 26% of videos had advertisements. The median number of total views per video was 31505 (range 488-3000133) and the median number of views per month was 854 (range 9-894873). Viewers seemed engaged with reported content with median likes of 209 per video compared to median of 18 dislikes per video. Viewer engagement seemed to be encouraged with 82% of videos allowing viewers to write comments and questions which video producers could respond to. There was a significant difference in the understandability and the actionability of content, as reflected by median PEMAT scores of 91% (range 23-100%) and 25% (range 0-100%) respectively. The median DISCERN score was 2 (range 1-5). On univariate analysis, there was an association with video content produced by medical practitioners with higher overall DISCERN and PEMAT scores (p = 0.03) but there was no association with the numbered listing on YouTube (p = 0.681), the number of likes (p = 0.883) or number of views (p = 0.786).

YouTube is a readily available, free medium for patients to search health conditions such as erectile dysfunction. This is particularly significant as patients may consult YouTube prior to a health practitioner. The limitation is that there is no governance in the quality of the content provided. Whilst the majority of video content was presented in a manner which was readily understandable, there were significant deficiencies overall in the citation of sources of information provided, discussion of treatment options including benefits and risks and a logical action plan for patients seeking treatment. Further there was evidence that this health condition remains stigmatised, with a lack of patient’s personal insights into the condition provided. Most notably the quality of content provided was not associated with viewer engagement.

Patients need to be counselled that while information is available on this platform, the overall quality of the content is poor. Consultation with a General Practitioner and Specialists is advised, where referral to appropriate additional sources of information can be advised, which may include specific videos reviewed on YouTube. If patients are seeking more information, they should seek videos produced by recognised medical institutions as an initial screening tool.

Alexa Internet. The Top 500 sites on the web. Available at: https://www.alexa/com/topsites; Accessed April 7 2021
Agency for Healthcare Research and Quality. The Patient Education Materials Assessment Tool (PEMAT) and user’s guide. Available at: https://www.ahrq.gov/ncepcr/tools/self-mgmt/pemat-av/html/; Accessed April 5 2021
DISCERN Online. Quality criteria for consumer health information. Available at: www.discern.org.uk/index/php; Accessed April 5 2021