A content analysis of YouTube videos on interproximal enamel reduction

INTRODUCTION

Interproximal enamel reduction (IPR) is routinely undertaken in orthodontic treatment to create minor intra-arch space.^[1] IPR involves the selective removal of proximal enamel between teeth while preserving the natural shape of teeth.^[2] It may be utilized alongside active orthodontic treatment for a Bolton discrepancy, mild crowding, midline shift, and black triangles.^[3,4]

Nowadays, patients turn to online resources to gather information before making decisions.^[5] In the field of dentistry, patients have many resources to retrieve health-related information from different platforms. YouTube, established in 2005, is an online video-sharing platform that has steadily grown in popularity, with approximately 5 billion videos viewed each day.^[5] Although it has become the most visited website for accessing health-related videos, this platform may potentially contain inaccurate information as YouTube permits content without regulation, peer review, or moderation.^[5-7]

It is crucial to evaluate the credibility of videos to assist dental professionals in choosing a video with evidence-based information for patient education.^[8-10] Studies evaluating the credibility of information (COI) of dental videos on YouTube using the Journal of the American Medical Association (JAMA) benchmarks concluded their results differently.^[8-10] Ozsoy concluded that smile design videos from YouTube depicted fair credibility.^[8] According to Kodonas and Fardi, videos on vital pulp treatment from YouTube are low in credibility.^[9] However, Olkun et al. reported that online information on lingual orthodontics was of poor credibility with a low JAMA score.^[10]

Patients must be informed about the dental treatments offered to them.^[11,12] Therefore, the educational value (EV) of YouTube videos on IPR needs to be evaluated for accuracy and entirety. There are various studies that have evaluated the EV of dental videos on YouTube using different tools. A study by Meade et al. reported that the quality of information related to orthodontic retention and retainers was deficient on YouTube.^[11] Another study by Yahya et al. investigated the quality of information related to temporary anchorage devices on YouTube and found the EV of the videos to be inadequate.^[12]

Understandability can be explained as the comprehension of the key message of a video by patients from diverse backgrounds. Actionability, on the other hand, is defined as the capability of viewers to identify what they can do based on the audiovisual information provided.^[13] It is mandatory to analyze the understandability of information (UOI) and actionability of information (AOI) of YouTube videos. The patient education materials assessment tool for audio-visual material (PEMAT-A/V) assesses how well the audio-visual (A/V) material addresses organization, reliability of visual aids, word choice, and overall clarity. PEMAT-A/V will identify the IPR videos that are easy to understand and act on.^[14]

IPR has been widely utilized in dentistry and performed by specialists as well as general dental practitioners.^[1] Even though there are some studies examining different dental procedure-related content on YouTube, there is a paucity of research to appraise the accuracy and reliability of the content of videos on IPR.^[5,14] YouTube videos can play a role in shaping public opinion about IPR. Therefore, this study aimed to evaluate the COI, EV, UOI, and AOI of YouTube videos on IPR for patient education.

METHODS

The study design was a process-based audit, as the information available on YouTube was being examined. This study was approved by the Joint Research and Ethics Committee of the University vide grant no.: BDS I-01-2023(18).

Inclusion and exclusion criteria

The videos, which were (1) >1 minute duration, (2) with English narration, (3) uploaded between 2014 and 2023 with (4) content relevant to IPR, were included in the study. The exclusion criteria included (1) duplicate videos, (2) YouTube shorts, and (3) video duration > 15 minutes. The video selection is shown in [Figure 1].

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Figure 1:

Interproximal enamel reduction-related domains.

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RESULTS

A total of 29 videos were found to be eligible for analysis, as shown in [Figure 2]. The descriptive statistics are presented in [Table 4]. Most videos were uploaded by dental professionals (13 [44.82%]), followed by academic institutions (8 [27.58%]), a company or commercial organization (7 [24.13%]), and patients (1[3.44%]), respectively.

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Figure 2:

Flowchart showing video selection.

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The mean COI score for each criterion is depicted in [Table 5]. This table shows that currency is clearly portrayed in all videos, followed by disclosure and authorship, whereas attribution for references and copyright information were least covered. [Figure 3] depicts the COI scores of all videos where only two videos display high COI.

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Figure 3:

The overall credibility of information score using JAMA benchmark. JAMA: Journal of American Medical Association.

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Considering the different parameters for COI: Attribution scored the lowest with 0.21 ± 0.41, as only 6 videos scored 1, 18 videos scored 1 for “authorship,” 21 videos scored 1 for “disclosure,” and “currency” scored the highest for all 29 videos.

[Table 6] shows the mean EV score for each domain. The domain “procedure” scored the highest with a mean of 1.38 ± 0.94, followed closely by “different methods” and “definition,” while “post procedural instructions” scored the lowest mean of 0.17 ± 0.47 followed by “contraindications,” “safe amount of tooth grinding,” and “complications.” [Figure 4] shows overall EV scores, where only one video scored above 18, indicating that most videos had inadequate EV.

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Figure 4:

The overall educational value scores of YouTube videos.

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[Figure 5] depicts the mean scores for each category for UOI and AOI parameters. In the UOI aspect, all videos made the purpose evident and were presented sequentially and used simple language (26 [89.66%]). However, only 1 (3.45%) video summarized key points at the end and just 10 (34.48%) videos had headers for different parts for ease in understanding.

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Figure 5:

The overall mean patient education materials assessment tool for audio (UOI)-visual material scoring criteria for understandability of information and actionability of information (AOI).

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Considering the AOI, 20 videos (68.97%) clearly identified at least one action for the user but only four videos (13.79%) addressed the user directly.

[Figure 6] shows the overall scores of UOI and AOI. Considering the PEMAT-A/V criteria of scoring at least 70% and above, good UOI and AOI were seen in 17 and 3 videos, respectively.

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Figure 6:

The overall understandability of information and actionability of information scores.

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The intra and inter-rater reliability was compared by ICC. The ICC values were defined according to current literature, with 0.40 as poor, 0.40–0.59 as fair, 0.60–0.74 as good, and 0.75–1.0 as excellent. The intra-rater reliability (T.W.Y. and T.J.S.) for COI, EV, and PEMAT-A/V was 0.82, 0.99, and 0.99, and 0.90, 0.99, and 0.99, respectively, indicating strong intra-rater reliability. The inter-rater reliability of COI, EV, and PEMAT-A/V was 0.77, 0.99, and 0.94, respectively.

DISCUSSION

There is a rise in the number of patients using the internet to search for health-related information.^[19,20] According to YouTube analytics, the majority of users are 25–34 (20.7%) years and 35–44 (16.7%) years which are the fastest-growing demographics on the platform.^[21] Furthermore, people prefer to obtain information from A/V sources in comparison to printed online educational materials.^[22] Studies conducted across multiple specialties have assessed A/V education materials and have concluded that online materials are often inaccurate and incomprehensible.^[23] Many studies have evaluated the quality of oral healthcare videos on YouTube pertaining to dental procedures. As YouTube allows free uploads, the quality of the content cannot be controlled.^[24,25] Therefore, it is crucial to evaluate the credibility of oral health-related videos on YouTube to ascertain the reliability and accuracy of authors’ credentials, content sources, and ownership disclosure.^[11] The COI, EV, UOI, and AOI of YouTube videos for obtaining information about procedures are debated due to the lack of standardization in video content.^[25]

The mean duration of the 29 videos assessed was 230 seconds (3.8 min), a little shorter than other studies about orthodontic clear aligners and lingual orthodontics, with a mean duration of 7.40 min and 4.42 min, respectively.^[25,26] According to Chauvet et al, the video duration should be <10 min to maintain the patient’s focus and attention span, implying that the videos presented with an acceptable duration.^[27]

The mean number of views per video was 74,815 ± 103,110 [Table 4], which lies within the average number of views of 10,765 recorded for YouTube videos on lingual orthodontic treatment and 113,839 recorded on orthodontic clear aligners.^[25,26] The number of subscribers showed a mean score of 56,704 ± 78,765, with 687.48 ± 1044.70 mean number of likes. The videos were uploaded since a mean of 60.79 ± 42.99 months, and the mean viewing rate was 77.17%. All these values lean toward the upper range, reflecting the scarcity of information available to patients about IPR. Most videos were uploaded by dental professionals which highlights a need for the development of a framework for making dental videos for patient education.

Intra-rater and inter-rater scores in this study for COI, EV, UOI, and AOI were high, indicating the reliability of JAMA for scoring COI, the novel tool for assessing EV and PEMAT (A/V) to gauge the UOI and AOI of the videos in this study.

JAMA is a tool that evaluates the reliability and plausibility of videos.^[8] The results from this study showed that the COI of videos about IPR uploaded to YouTube was deficient at a mean score of 0.62. Olkun et al. reported that the average mean of JAMA benchmarks for videos on lingual orthodontics was 1.71.^[10] As shown in [Figure 3], only two videos scored 4 for JAMA benchmarks as indicated below: (1) “Flash -IPR Process” by Flash Orthodontics (ln.run/g6nnC) and (2) “Orthostripping with disc” by Dental Movies (ln.run/wyGAg). These findings highlight the deficiency in COI, especially regarding authorship, attribution, and disclosure. Attribution is defined as acknowledgment of copyright information and references to the content.^[10] Attribution received the lowest score, undermining the scientific credibility of the videos. Consequently, these videos may not be evidence-based or convey information derived from expert opinions. Only six videos scored 1 for attribution, depicting a COI, similar to Olkun’s et al. study, in which only two videos scored 1 for attribution.^[10] It is important to evaluate the attribution of oral health-related videos on YouTube to ensure that individuals are not misled by information which is not evidence based.^[15] The currency domain, which indicates funding and sponsorship, scored high for all videos.

The EV scoring systems used in this research were adapted from similar YouTube video analysis studies related to oral health.^[12,17,28] Most videos contained information about the procedure of interproximal reduction (86.2%) and the different methods of performing IPR (79.3%). The indications for performing IPR (72.4%) were also explained in most of the videos. On the other hand, most videos failed to provide post-procedural instructions (13.8%) and contraindications (6.9%) for IPR. These values imply a paucity in the domains that guide the patient with post-operative hygiene maintenance and the cases which are contraindicated for IPR. Only one video attained a score of 19, indicating a high EV: “Work Tips: Interproximal Enamel Stripping (IPR)” by VinciSmile USA (ln.run/b60yo). Both the overall EV score and domain score for post-operative care are comparable to the study on the analysis of YouTube videos with miniscrew anchorage.^[12]

YouTube videos on IPR are applicable as a source of patient education; hence, UOI and AOI were investigated using the PEMAT-A/V. This tool assesses the video and can be used by untrained professionals, making it an easy-to-use tool. Unfortunately, no dental health-related research employing the PEMAT-A/V tool was found in the literature. Almost 17 videos, i.e., 58.72% obtained a good UOI score, which depicted that patients from diverse backgrounds and literacy could understand IPR. However, only three videos, i.e., 10.34% of videos had good AOI scores, implying that very few videos could guide the patient with post-operative care.

Rubel et al. reported 35% and 37.5% of videos with good understandability and good actionability scores, respectively, for analysis of YouTube videos on sinusitis.^[29] In the analysis by Salama et al., understandability and actionability scores of 54.5% and 21.8%, respectively, were found for videos on hypospadias reporting higher AOI scores.^[30]

The mean UOI was found to be good at 71.93% in contrast to the 65% of videos reported as low in terms of understandability scores of YouTube videos on sinusitis.^[30] Some IPR videos (6) had actionability scores of 0% whereas 20 videos had actionability scores ≤70%, relatively similar in actionability score in comparison with YouTube videos on sinusitis.^[29] The overall understandability score of our videos was good; however, the actionability score was generally poor. Most videos lost the AOI scores for not addressing the user directly when describing actions, which hindered their actionability. Only one video attained a score of 100% for both UOI and AOI, indicating that this video was easy to comprehend and implement: What is and How to use Orthodontic Interproximal Reduction Kit|Waldent IPR Kit’ by Dentalkart (ln.run/XvGXb).

The content analysis depicted that the number of videos with high credibility, EV, along with understandability and actionability, is very limited depicting that currently, YouTube is inadequate as a source of information for IPR. Thus, health professionals must guide patients to reliable content to help patients understand better.

This study has many limitations, like only English language videos being assessed which may limit the generalizability of the findings. This is a cross-sectional study; thus, time-specific changes in video characteristics could not be recorded. Only the top 50 videos were analyzed for 6 search terms related to IPR; hence, a possibility exists that we may have missed other related content. We recommend that similar studies be conducted periodically in the future to update the improvement of JAMA, EV, and PEMAT-A/V scores for online IPR videos.

These results imply that YouTube is a poor source to retrieve information about IPR; thus, the links of IPR videos with high scores in COI, EV, understandability, and actionability have been provided to assist the dental professionals in guiding their patients, as no video was found to have high scores in all aspects.

CONCLUSION

The credibility, EV, understandability, and actionability of IPR on YouTube are unreliable and deficient. This study demonstrated that even though the IPR videos have good understandability, they show poor actionability as they do not motivate action in viewers.

As more patients are turning to YouTube for health-related information, dental professionals need to be vigilant about the ease of access to unreliable content by patients and guide patients towards authentic and evidence-based content.

Dental professionals, societies, and academic institutions should consider developing high-quality content that is evidence-based to align with the needs of the targeted patient population to guide prospective patients. This study may provide guidelines to produce appropriate and high-quality patient education videos.