Journal of Consumer Health on the Internet

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wchi20

Evaluation of the Content Quality of YouTube

Videos on Alternate Therapies for Prevention or
Treatment of COVID-19

Sarvesh Sawant, Aswathi Nair, Shaik Aisha Sultana, Arjun Rajendran & Kapil
Chalil Madathil

To cite this article: Sarvesh Sawant, Aswathi Nair, Shaik Aisha Sultana, Arjun Rajendran & Kapil
Chalil Madathil (2021) Evaluation of the Content Quality of YouTube Videos on Alternate Therapies
for Prevention or Treatment of COVID-19, Journal of Consumer Health on the Internet, 25:2,
133-155, DOI: 10.1080/15398285.2021.1902226

To link to this article: https://doi.org/10.1080/15398285.2021.1902226

Published online: 16 Jun 2021.

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JOURNAL OF CONSUMER HEALTH ON THE INTERNET
2021, VOL. 25, NO. 2, 133–155
https://doi.org/10.1080/15398285.2021.1902226

Evaluation of the Content Quality of YouTube Videos

on Alternate Therapies for Prevention or Treatment of
COVID-19
Sarvesh Sawanta, Aswathi Nairb, Shaik Aisha Sultanac, Arjun Rajendrand, and
Kapil Chalil Madathila,c,e
a
Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA;
b
School of Public Health, The University of Texas Health Science Center at Houston, Houston,
Texas, USA; cGlenn Department of Civil Engineering, Clemson University, Clemson, South
Carolina, USA; dCentre for Endocrinology and Diabetes, School of Medicine, Amrita University,
Kochi, India; eDepartment of Public Health Sciences, Medical University of South Carolina,
Charleston, South Carolina, USA

ABSTRACT ARTICLE HISTORY

The objective of this study was to identify and assess the charac- Received 16 June 2020
teristics and content quality of the YouTube videos suggesting Accepted 9 March 2021
alternatives for either treating or preventing COVID-19 and their
KEYWORDS
perception among the viewers. A comprehensive electronic
Alternate therapy;
search was conducted on YouTube, resulting in a total of 120 COVID-19; content quality;
videos being selected for the study based on view count and YouTube; DISCERN
relevance. The videos were evaluated for their content quality
using the JAMA and DISCERN scoring system by two reviewers.
Their mean DISCERN scores indicate the 20.8% of the videos
were of very poor quality, 34.2% poor, 30.0% average, 11.7%,
good and 3.3% excellent. In addition, 40.8% of the videos were
classified as misleading, 37.5% as useful and 21.7% as neither/
nor. Blogs/short films were the most predominantly used media
type for spreading misleading information in the videos, while
government agencies and health information channels shared
useful videos with evidence-based information. There was a
poor correlation between the viewer’s ratings and the quality
assessment findings. Interventions by government agencies and
professional medical organizations are necessary to improve the
quality standard of the health care information disseminated
through YouTube.

Introduction
The Internet has become a popular source of healthcare information for
both healthcare professionals and the general public (Cuan-Baltazar et al.
2020; Madathil et al. 2015). In fact, studies have found that the Internet
has become the primary source of health-related information for most

CONTACT Kapil Chalil Madathil kmadath@clemson.edu Department of Industrial Engineering, Clemson

University, Clemson, South Carolina, USA; Glenn Department of Civil Engineering, Clemson University, Clemson,
South Carolina, USA; Department of Public Health Sciences, Medical University of South Carolina, Charleston,
South Carolina, USA.
ß 2021 The Author(s). Published with license by Taylor & Francis Group, LLC
134 S. SAWANT ET AL.

people across the globe (AlGhamdi and Moussa 2012; Griffiths et al. 2012;
Andreassen et al. 2007). Internet users, people with health concerns and
patients use the Internet to find information about a specific disease, obtain
second opinions, find alternative sources of treatment and communicate
with others with similar medical conditions about their experiences and the
treatments they adopted. In addition, people often buy drugs or look for
healthcare treatment plans and providers on the Internet (van Uden-Kraan
et al. 2009; Sadasivam et al. 2013; Scharett et al. 2017; Agnisarman et al.
2018). Internet-based peer support groups is one other form of online
media that enables healthcare consumers to share their concerns and expe-
riences, encompass forums, discussion groups, chat rooms, and listservs.
Most peer support groups are forums, where users can create accounts and
post discussion threads to which other users can reply. Recent studies have
reported that users of such peer support groups share personal experiences,
encourage one another, and exchange advice (Madathil et al. 2013; Ponathil
et al. 2021; Narasimha et al. 2019).
Google sees approximately 6.75 million health-related searches every day
(Eysenbach and K€ ohler 2002), and more than 70% of adult Internet users
in the United States search for healthcare-related information (Fox and
Duggan 2013). Eighty percent of the total users who trust the healthcare
information accessed on the Internet have chronic conditions (Madathil
et al. 2015). However, many online sources contain misleading, false, or
biased information, making it difficult for this number of users to distin-
guish between reliable and misleading information (Young 2011; Madathil
and Greenstein 2018; Madathil, Greenstein, and Koikkara 2014).
Of these Internet sources, YouTube, which is used by millions to find
information on various topics including healthcare, has emerged as the
most popular free video-sharing platform, with 500 h of videos uploaded
per minute. Currently, it has 30 million daily active users and 2 billion
monthly users, with more than 95% of the global Internet population
watching YouTube daily (Mohsin 2020). According to Alexa’s top 500 glo-
bal sites, YouTube is ranked second in terms of daily page views (Alexa -
Top Sites, n.d.). YouTube is extremely effective in disseminating content
without regards for the accuracy or reliability of the information because of
its widespread popularity (Brna et al. 2013; Madathil, Greenstein, and
Koikkara 2014). It is important that correct information is made available
through platforms like YouTube to encourage the viewers to comply with
the preventive guidelines and practice the behavior required to prevent the
spread of diseases (Rubin et al. 2009).
Keelan et al. (2007) analyzed the videos on YouTube focusing on
immunization-related content, discovering multiple incidents of misinfor-
mation. In a study related to the analysis of the content quality of
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 135

YouTube video on rheumatoid arthritis, results indicated that one third of

videos were misleading (Singh, Singh, and Singh 2012). R€ ossler et al. (2012)
performed Quality assessment of lumbar puncture and neuraxial block tech-
niques on YouTube and identified that the overall quality of videos was low.
The authors suggested that more high-quality, and institutional medical
learning videos should be made available on YouTube. Research conducted to
determine if YouTube videos related to seizure were misleading found that
only one third of the videos designated as “seizures” actually depicted a seiz-
ure scenario (Brna et al. 2013). The authors exercised caution in the use of
YouTube for accessing educational or self-diagnosis aids for seizures (Brna
et al. 2013). In a 2014 study on the use of YouTube as a source of patient
information on gallstone disease, more than half of the videos were identified
as misleading (Lee, Seo, and Hong 2014).
Various studies have also shown that YouTube can be an effective
medium for propagating reliable information, one that could help mitigate
confusion and educate people on how to prevent, treat or manage specific
diseases and medical conditions. Sood et al. (2011) analyzed YouTube vid-
eos as a source of information on kidney stone diseases and found that
58.3% of the analyzed videos had useful content. A 2010 study on the use
of YouTube as a source of information on the H1N1 Influenza pandemic
of 2009, stated that YouTube had a substantial amount of evidence-based
information about the Influenza pandemic with 61.3% of the total videos
analyzed marked as useful (Pandey et al. 2010). Contradicting results from
various clinical research studies have led to a confusion among viewers
about the quality of the content in YouTube videos, and, thus, it becomes
imperative to analyze the reliability and accuracy of the videos before
accessing them for educational or self-diagnosis purposes.
This use of the Internet and YouTube is particularly important today
because of the impact of the novel Coronavirus (COVID-19), an infectious
disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) (Rocke et al. 2020; Mayo clinic 2020). The first case was reported
in December 2019 in Wuhan, the capital of Hubei Province in China, and
since then it has affected the majority of the world, resulting in it being
declared a pandemic and a global health emergency by the World Health
Organization (WHO) in early 2020 (Hui et al. 2020; WHO 2020). The
most prominent symptoms of COVID-19 include fever, cough, and sore
throat, accompanied by fatigue, shortness of breath, muscle and abdominal
pain, and diarrhea (Rocke et al. 2020; CDC 2020; WHO 2020). Temporary
loss of smell, or anosmia, is one of the earliest and most commonly
reported indicators of COVID-19 (Rocke et al. 2020; Menni et al. 2020).
The majority of the cases have shown mild symptoms, but a few have pro-
gressed to viral pneumonia and multi-organ failure (Hui et al. 2020; CDC
136 S. SAWANT ET AL.

2020). With no clinically proven medication or vaccine for the disease,

many have turned to Internet sources, including YouTube, for information
about treating or preventing this virus (WHO 2020). However, past
research on the accuracy of healthcare information on YouTube has found
that it includes misleading information contradicting reference standards
(Madathil et al. 2015). This study was conducted during the initial stage of
the pandemic (April 2, 3, 4, and 11, 2020) and its overall objective was to
assess the quality of YouTube videos providing information on the preven-
tion and treatment of COVID-19. The specific research objectives are
listed below:
Objective 1: To investigate the quality of the content of the 120 YouTube videos
included in this study as a source of medical information on alternative therapies to
treat or prevent COVID-19 by applying two scoring instruments.
Objective 2: To identify the source of the uploaded content, the purpose of
uploading the content, and the media type of the YouTube videos included in
the study.
Objective 3: To correlate quality assessment findings with the user ratings measured
in likes, to analyze if users were successful in identifying the high quality content.

Methodology
We analyzed social media trace data related to the COVID-19 pandemic
posted on YouTube one of the most popular social media platforms. In the
sections below, we describe how we collected and analyzed our data.

Search strategy
The search phrases “alternate therapy for the treatment of COVID-19” and
“alternate therapy to prevent COVID-19” were entered into the YouTube
search bar (http://www.youtube.com) through the Google Chrome browser
on April 2, 3, 4, and 11, 2020. Videos were selected by filtering based on
view count and relevance, with 120 videos being selected based on this
search strategy and the snowball technique. Snowball sampling is a tech-
nique in which we analyze data that comes as a recommendation based on
the previous data we analyzed (Wasserman and Faust 1994). In this study,
using the snowball sampling technique, we analyzed specific videos that
were recommended by YouTube recommendation engine as “Up next” vid-
eos based on the previous video we watched. These videos have the similar
traits as the videos we analyzed through our search. To limit filtering to
previous user history and to expand the search results, the “Incognito” set-
tings were selected. Incognito Mode is a privacy feature online on Google
Chrome browser that prevents the storage of a user’s browsing history.
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 137

Figure 1. Data collection strategy.

Videos clip of under 30 s, non-English language videos without English

subtitles, and videos containing information irrelevant to the topic were
excluded from the study. Video under 30 s of length were too short and
did not present information directly related to either the prevention or
treatment of the coronavirus as observed during the video selection phase.
In addition, English is the primary language of the two coders, and since it
would have been difficult for them to understand the content of the videos
in other languages, we excluded those from our analysis.
Figure 1 describes the search strategy used in this study. The search
strategy yielded a total of 540 videos for the search phrase “alternate ther-
apy to prevent COVID-19” and 601 videos for the search phrase “alternate
therapy for the treatment of COVID-19.” Of the total 1,141 videos 160 vid-
eos were non-English language videos or without subtitles. After careful
analysis of the remaining videos, the top 100 videos based on relevance
and view count were selected for the study. These videos specifically deliv-
ered information on methods to prevent or treat COVID-19 and had a
view count of at least 50 views. We also analyzed the video recommended
by YouTube as “Up next” based on its relevance to the topic and identified
138 S. SAWANT ET AL.

an additional 20 videos that were included in the study, resulting in a total

of 120 videos. We analyzed social media trace data related to the COVID-
19 pandemic posted on these YouTube videos.

Data collection
Video features including video title, video URL, clip length, view count, upload
date, likes, dislike, comments, channel name, number of subscribers, video
description (Yes/No) were recorded in an excel spreadsheet. In addition, the
Video Power Index (VPI) was calculated for each video using (1) to determine
the popularity of the videos (Kuru and Yener Erken 2020):
 
like count
VPI ¼ 100 (1)
dislike count þ like count
The mean daily view count of the videos was calculated using (2) and
(3) (Kuru and Yener Erken 2020):
total view count
Mean daily view count ¼
number of days since the video was uploaded
(2)
number of days since the video was uploaded
¼ Search date  upload date (3)

Quality assessment
To address the first research objective, we conducted a quality assessment
of the videos included in this study. All 120 videos and titles were viewed
by two researchers and evaluated using the Journal of the American
Medical Association (JAMA) and the Quality Criteria for Consumer Health
Information (DISCERN) scoring systems (Silberg, Lundberg, and
Musacchio 1997; Charnock et al. 1999). To ensure objectivity, the JAMA
and DISCERN scores were recorded separately by the two observers. These
scores were subsequently averaged to calculate the mean JAMA score using
(4) and mean DISCERN score using (5) (Kuru and Yener Erken 2020):
JAMA score of reviewer 1 þ JAMA score of reviewer 2
Mean JAMA score ¼
2
(4)
DISCERN score of reviewer 1 þ DISCERN score of reviewer 2
Mean DISCERN score ¼
2
(5)
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 139

Table 1. JAMA scoring system (adopted from Kuru and Yener Erken 2020).
Rating
Section Information No Yes
Attribution Sources and references for all content being evaluated 0 1
should be listed, and all relevant copyright
information should be displayed or mentioned.
Authorship Authors and contributors should be mentioned with
their affiliations, and relevant credentials should be
provided clearly.
Disclosure Website “ownership” should be prominently revealed. 0 1
Any advertising, sponsorship, commercial funding
arrangements or support, or potential conflicts of
interest should be disclosed.
Currency There should be clear indication of the dates when 0 1
content was posted and updated

JAMA scoring system

The JAMA system, which is a quality scale used to evaluate healthcare
information obtained from the Internet, comprises the four criteria of
Authorship, Attribution, Disclosure, and Currency. Each criterion is eval-
uated on a two-point scale, 1 if the content meets the desired criteria and 0
if it does not, meaning content can receive scores ranging from a max-
imum of 4 to a minimum 0, with higher scores suggesting a higher quality
of the content being evaluated (Silberg, Lundberg, and Musacchio 1997).
Table 1 illustrates the scoring guidelines for the JAMA scoring system.

DISCERN scoring system

The DISCERN system, the second tool used to evaluate the quality of the
120 videos investigated in this study, was developed collaboratively by the
British Library and Oxford University to be used by healthcare consumers.
The system uses a 5-point scale to assess the quality of the videos, the total
score ranging from 15 to 75 points. This scoring system features two sec-
tions, with the first comprising a set of eight questions addressing the reli-
ability of the publication and the second including seven questions
focusing on the quality of information about treatment choices. Table 2
describes the scoring guidelines for the DISCERN scoring system.
DISCERN scores ranging between 75 and 63 points were classified here
as “excellent,” 62 and 51 as “good,” 50 and 39 as “average,” 38 and 28 as
“poor,” and < 28 “as very poor” with higher scores indicating a higher
quality of information (Charnock et al. 1999).

Data analysis
To assess the content related quality of the video uploaded on YouTube,
we conducted a statistical analysis and content analysis to determine the
140 S. SAWANT ET AL.

Table 2. DISCERN scoring system (adopted from Kuru and Yener Erken 2020).
Section Question No Partly Yes
Reliability of the publication Explicit aims 1 2 3 4 5
Aims achieved 1 2 3 4 5
Source of information 1 2 3 4 5
Relevance to patients 1 2 3 4 5
Bias and Balance 1 2 3 4 5
Currency (date) of information 1 2 3 4 5
Reference to areas of uncertainty 1 2 3 4 5
Additional sources of information 1 2 3 4 5
Quality of information on treatment choices Benefits of treatment 1 2 3 4 5
How treatment works 1 2 3 4 5
No treatment options 1 2 3 4 5
Risk of treatment 1 2 3 4 5
Other treatment options 1 2 3 4 5
Quality of life 1 2 3 4 5
Shared decision making 1 2 3 4 5

purpose of uploading these videos, their media type, and their source infor-
mation (category and type), subsequently classifying these videos as either
useful, misleading or neither/nor (Pandey et al. 2010; Murugiah et al. 2011;
Sood et al. 2011; Singh, Singh, and Singh 2012).

Content analysis of YouTube videos

To address the second research objective, we performed a content analysis on
the YouTube videos. The primary purpose of conducting a content analysis
was to analyze what type of content YouTube users share when they post vid-
eos about COVID-19. We chose content analysis because it provides a sys-
tematic way to help us describe the video features (Joffe and Lucy 2004).
Categories in which we used to analyze each video have been summarized in
Table 3. Two reviewers independently reviewed all the videos. First, we coded
each video for media type by identifying the production format of each (i.e.,
digital media, blog/short film, news, and personal videos) (Kuru and Yener
Erken 2020). Second, we coded for the stated purpose for uploading the con-
tent (i.e., general information, recommendation and raise awareness) to help
understand the motive of the uploaders. Third, we coded to understand the
source of the videos (i.e., General content creators and Healthcare specific
content creators). Fourth, we further subdivided the content creators to iden-
tify their types (i.e., independent users, government agencies, health informa-
tion channels/sites, news channels, professional organizations, Non-
Government Organizations (NGOs) and University channels). Finally, the
two reviewers coded the videos as useful, misleading or neither/nor videos
with an acceptable interrater reliability indicated by a Cohen’s kappa (j) value
of 0.78. Videos were marked useful if they presented accurate information
taken from a reliable source and considered misleading if they prescribed or
promoted the use of chemicals, technology, or medicine that hadn’t been
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 141

Table 3. Coding strategy adopted for content analysis (Kearney et al. 2019).
Theme Code Description
Media Type Blog/Short Film Short film depicting people sharing their experience/
opinions or a blogger (presenter) discussing a topic
Digital Media Videos without a presenter (animations/ slide shows)
News Videos containing clips from news channels, personal
interviews/panel interviews
Personal Video Video shot from personal devices
Purpose of the video Recommendation Video recommending specific type of treatment or
remedy to fight the symptoms of COVID-19 or to
cure the virus
Raise Awareness Videos discrediting myths, promoting information
regarding possible misconceptions, answering
specific question related to the pandemic.
General Information Videos sharing facts about the symptoms, causes,
precautionary measures and immunity strengthening
techniques against flu and cold
Video quality content Misleading Videos promoting information without known scientific
evidence or proof
Useful Videos promoting scientifically sound information with
known scientific evidence for their claims,
suggestions and recommendations
Neither/nor Videos which cannot be directly classified as either
misleading or useful because they contain evidence
but the information was incomplete or insufficient
Content Uploaders Independent Users Content creators who are not linked to any
organization
Government Agency YouTube channels run by government agencies (Center
for Disease Control (CDC)) or the United States
Department of Health and Human Services (HCC))
Health Information YouTube channels or websites specifically providing
Channel/Sites healthcare specific information
News Channel YouTube channels of news agencies
Professional Organization Content creators who are a part of a professional
organization which is not government owned or an
educational institution or a nonprofit organization.
University Channel YouTube channels run by educational institutions
NGO YouTube channels run by nonprofit organizations
Source Type General Channel creates content which covers all domains
including healthcare related videos.
Health Related Channels creating healthcare specific videos only.

clinically approved by a professional or a healthcare organization (Fat et al.

2011). The coders participated in a consensus meeting to resolve any inter-
rater discrepancies. The coder’s decisions were blinded from each other
before the consensus meeting.

Statistical analysis
IBM SPSS 24.0 statistical software was used to analyze the data in the study.
These analyses included descriptive statistics, the Cronbach’s a value, and
Spearman’s correlation coefficient to evaluate the degree of agreement
between the observers. To determine the presence of significant differences
across the mean DISCERN and JAMA scores with the VPI value between the
content creators focusing specifically on healthcare-related videos and the
general content creators, an independent sample t-test was used with a 95%
142 S. SAWANT ET AL.

confidence interval. Post-hoc comparisons were used to determine the locus

of significant differences. For evaluating the correlation coefficient, r:
0.75–1.0 was considered as very strong, r: 0.50–0.74 as strong, r: 0.25–0.49 as
moderate and r: 0–0.24 as poor. Cronbach’s alpha values in the range of
0.71–0.90 were considered excellent, 0.61–0.70 as acceptable, 0.51–0.60 as
poor and values 0.50 were considered unacceptable.

Results
The 120 most relevant videos selected for this study had a total of
27,515,592 views and a total duration of 10 h and 47 min, with an average
of 5 min and 39 s per video. In this section we will describe the general
characteristics of the videos followed by analyzing the content quality of
YouTube videos disseminating information about alternate therapies for
COVID-19 and finally, we will evaluate the level of correlation between the
quality assessment findings and user ratings.

General characteristics of the videos

The general features of the videos were analyzed, with the results showing
that 44.2% of the videos (n ¼ 53) were uploaded by individual content crea-
tors followed by news channels with 26.7% (n ¼ 32), 11.7% videos (n ¼ 14)
by health information channels/sites, 6.7% of the videos (n ¼ 8) by govern-
ment agencies, 6.7% (n ¼ 8) by other professional organizations, 3.3% (n ¼ 4)
by university/academic channels and 0.8% (n ¼ 1) by nonprofit organiza-
tions. These were further sub-classified as general content creators (n ¼ 69,
57.5%) and health-related content creators (n ¼ 51, 42.5%). The media types
predominantly used by the sources were blogs/short movies (n ¼ 38, 31.7%),
followed by news (n ¼ 34, 28.3%), digital media (n ¼ 31, 25.8%), and per-
sonal devices (n ¼ 17, 14.2%). Of these videos, 40.8% (n ¼ 49) disseminated
general information about the COVID-19 pandemic, with 29.2% (n ¼ 35)
aiming to raise awareness through their content, and 30.0% (n ¼ 36) provid-
ing recommendations to either treat or prevent COVID-19. The content ana-
lysis results have been summarized in Tables 4 and 5.
Video lengths (minutes), total view counts, days since uploading, view
counts (daily), comment counts, like counts, dislike counts, and VPI values
are given in Table 6. For two videos the like and dislike counts were 0; there-
fore, a valid VPI could not be calculated. These two videos explained how
community transmission works in the spread of COVID-19 and what pre-
ventive measures could be taken to avoid getting infected and mitigating the
spread of the virus.
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 143

Table 4. General characteristics of the videos.

Variables Category N %
Video uploaders Independent users 53 44.1
Government agency 8 6.7
Health information channel 14 11.7
News channel 32 26.7
Professional organization 8 6.7
University channel 4 3.3
NGO 1 0.8
Video uploader’s category Healthcare specific content creators 51 42.5
General content creators 69 57.5
Original/Repost Original 115 95.8
Repost 5 4.2
Media Type Blog/short films 38 31.7
Digital media 31 25.8
News 34 28.3
Personal 17 14.2
Purpose General Information 50 41.7
Raise awareness 36 30.0
Recommendation 34 28.3

Table 5. Video uploaders classification.

Healthcare specific channels General content creators
Source type #Videos %Total #Videos % #Videos %
All videos 120 100.0 51 42.5 69 57.5
Independent users 53 44.1 21 39.6 32 60.4
Government agency 8 6.7 8 100.0 0 0.0
Health information channel 14 11.7 14 100.0 0 0.0
News channel 32 26.7 0 0.0 32 100.0
Professional organization 8 6.7 3 37.5 5 62.5
University channel 4 3.3 3 75.0 1 25.0
NGO 1 0.8 1 100.0 0 0.0

Table 6. Parameters of Video Power Index (VPI).

Variables Mean ± Standard Deviation Median (Maximum–Minimum)
Video length (minutes) 4:54 ± 4:02 3:28 (35:59–0:30)
View count 229,296.6 ± 500,027.6 34207.0 (3,747,383.0–62.0)
View count (daily) 16,376.9 ± 1989.6 1989.6 (470,718.0–2.7)
Time since video upload (days) 22.3 ± 15.4 20.5 (75.0–1.0)
Like count 4075.3 ± 12,099.2 302.5 (92,000.0–0.0)
Dislike count 213.4 ± 510.9 26.5 (4000.0–0.0)
Comment count 402.7 ± 829.8 52.0 (5482.0–0.0)
VPI (Video Power Index) (%) 90.0 ± 13.7 94.6 (100.0–19.4)

DISCERN and JAMA score comparison and evaluating the level of

concurrence between reviewers
The DISCERN and JAMA scored for the first reviewer were 39.6 ± 13.8 and
2.5 ± 0.9 respectively, while those for the second were 37.8 ± 9.2 and
2.6 ± 0.8, respectively. Thus, the mean DISCERN and JAMA scores were
38.7 ± 11.2 and 2.5 ± 0.8, respectively as shown in Table 7. We found a stat-
istically significant correlation and very strong concurrence between both
reviewers after examining their DISCERN scores using Spearman correl-
ation analysis (r: 0.880, p < 0.001, Cronbach’s a ¼ 0.906). Similarly, when
144 S. SAWANT ET AL.

Table 7. DISCERN and JAMA scores comparison between both observers.

Quality Scale Mean ± Standard Deviation Median (Maximum-Minimum)
DISCERN score (Reviewer 1) 39.6 ± 13.8 39.0 (73.0–20.0)
DISCERN score (Reviewer 2) 37.8 ± 9.2 37.0 (69.0–21.0)
DISCERN score (Average) 38.7 ± 11.2 37.8 (70.0–21.0)
JAMA score (Reviewer 1) 2.5 ± 0.9 2.0 (4.0–1.0)
JAMA score (Reviewer 2) 2.6 ± 0.8 3.0 (4.0–1.0)
JAMA score (Average) 2.5 ± 0.8 2.5 (4.0–1.0)

Figure 2. Number of videos, DISCERN, JAMA and VPI values of Heath care content creators and
general content creators.

their JAMA scores were examined using Spearman correlation analysis, a

statistically significant correlation and strong concurrence between both
were found (r: 0.661, p < 0.001, Cronbach’s a ¼ 0.778).

Evaluation of the difference among the mean DISCERN, JAMA and VPI
values between healthcare specific content and general content creators
Content creators focusing specifically on health-related topics had a better
DISCERN score overall and thus, better quality content in what they
uploaded about the COVID-19 pandemic. Figure 2 shows the difference
between the mean value of quality parameters of these two groups of con-
tent creators. The results of the independent sample t-test showed that the
mean DISCERN score was statistically higher for the group with only
health-related videos on their channels compared to the ones with videos
on various topics (p < 0.05, mean difference ¼ 8.7). JAMA scores were also
statistically higher for the healthcare-specific channels than for the general
content group (p < 0.05, mean difference ¼ 0.4). There was no statistically
significant difference between the VPI scores for the two groups (p ¼ 0.05).
Videos uploaded by channels supporting only healthcare-specific videos
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 145

Figure 3. Distribution of the quality of the videos according to the DISCERN scoring system.

received more views and likes on average (318,992 views, 5301 likes) than
general content creators (162,999 views 3,169 likes).

Quality assessment of the videos

According to the mean DISCERN scores of the two reviewers, the quality
of the videos was found as very poor in 20.8% (n ¼ 25), poor in 34.2%
(n ¼ 41), average in 30.0% (n ¼ 36), good in 11.7% (n ¼ 14), and excellent
in 3.3% (n ¼ 4) as shown in Figure 3.
Of the 120 videos investigated here 18 (15.0%) met the expected medical
standards (Excellent and good quality videos according to their mean
DISCERN scores), of which 50.0% (n ¼ 9) met the quality standard for dis-
seminating general information regarding the virus such as causes, symp-
toms, pathology, prevention techniques, and cure/vaccine updates. These
videos aimed at educating people on the importance of quarantining and
social distancing, how community transmission works, which age groups or
what medical conditions (diabetes, heart diseases, and chronic respiratory
disease) increase susceptibility to the virus, information regarding symp-
toms indicating a medical professional should be contacted or a test is indi-
cated, the supportive care (fluids, oxygen, ventilatory support) provided at
medical facilities and updates about the development of vaccines and treat-
ment plans.
Approximately one fourth, specifically 22.2% (n ¼ 4) videos provided recom-
mendations for the prevention or treatment of COVID-19, including strength-
ening immunity with sufficient sleep; moderate exercise; supplements
including Vitamin D, Vitamin C and Zinc (20 mg/day); adding probiotics and
146 S. SAWANT ET AL.

garlic to make use of its antiviral properties; maintaining hygiene and social
distancing measures and quarantining. The videos uploaded during the months
of March showed that clinical trials were being conducted on potential medica-
tions such as Remdesivir and hydroxychloroquine/chloroquine, both of which
showed promise in reducing respiratory symptoms. Currently, there is no clin-
ically approved cure for COVID-19. The treatments given for influenza and
other respiratory illnesses referred to as supportive care, are currently being
used to treat patients suffering from COVID-19.
Of the videos examined here, 27.8% (n ¼ 5) contributed to raising aware-
ness by discrediting myths, promoting information regarding possible mis-
conceptions, and answering specific question related to the pandemic,
specifically those related to the use of supplements Vitamin D and Vitamin
C as a treatment option, suggesting that these supplements could be poten-
tially used to strengthen immunity but are not identified as cures for
COVID-19. Additionally, these videos highlighted the possible implications
of the use of antiviral medications without consulting a physician and of
the use of potentially harmful substances that could lead to serious med-
ical issues.
Overall, 40.8% (n ¼ 49) of the videos were classified as misleading, and
37.5% (n ¼ 45) were classified as useful. Videos that couldn’t be classified
as either were termed as neither/nor (21.7%, n ¼ 26), with 34.7% (n ¼ 17)
of the total videos classified as misleading considered potentially harmful
because of possible chemical injury or other health-related issues.
Regarding potentially harmful videos, 52.9% (n ¼ 9) suggested the use or
consumption of potentially harmful substances that could lead to serious
medical issues and 47.1% (n ¼ 8) prescribed medications that were not offi-
cially approved by a government agency for the treatment of COVID-19.

Correlation of quality assessment findings with viewer’s rating

The total number of likes and dislikes for the videos were 489,039 and
25,604, respectively, yielding a like to dislike ratio of 19/1. Spearman’s cor-
relation analysis found that the viewer’s rating (likes) did not have a strong
correlation with the DISCERN and JAMA scores (r: 0.350, p < 0.001 and r:
0.364, p < 0.001, respectively). This indicates that viewers were unable to
appropriately rate the quality of the videos.

Discussion
The objective of this study was to evaluate the characteristics and content
quality of the YouTube videos providing information regarding the alterna-
tive therapies for preventing or treating COVID-19. Content analysis was
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 147

conducted to identify the themes and characteristics of the videos, and the
content quality of the videos was evaluated using two quality scales, the
DISCERN and JAMA scoring systems. Below we discuss the emerging
themes and theoretical implications of our findings. Subsequently, we pro-
pose interventions that could potentially improve the number and visibility
of high quality videos on YouTube.

Comparison with prior research

A similar study was conducted in 2010 to analyze the content related qual-
ity of YouTube videos as a source of information on the H1N1 Influenza
pandemic of 2009 (Pandey et al. 2010).This research was conducted during
the initial phase of the pandemic, similar to what was done in this study. A
total of 344 videos were screened and the authors found that only 16.2% of
the videos were misleading. When we compare these results with our find-
ings, we can see a substantial difference in the number of misleading vid-
eos, higher volume of videos contains false, misleading and biased
information about COVID-19 as compared to H1N1 influenza. This could
be due to a fact that the COVID-19 pathogen is a new strain of virus and
there is a big information gap with respect to it. This has created a global
need for research and documentation but at the same time has encouraged
content creators to fill this void by false and detrimental information. In
contrast to the approach adopted in H1N1 study, we additionally sorted
the search results by view counts. This was done to acquire a set of videos
of high relevance owing to large viewership. Another critical aspect is that
the H1N1 influenza study did not make use of any quality assessment tools
to analyze the content quality of their videos, thus a direct comparison
between both the studies would be inappropriate. Various studies in the
past on the accuracy of healthcare information on YouTube has found that
it includes misleading information contradicting reference standards
(Madathil et al. 2015). Thus, it becomes essential to gauge the quality
standard of any information prior to using or circulating it as a source of
educational or self-diagnosis medium.

Impact of false and potentially misleading information on people’s

well being
The line distinguishing credible information from misleading content is
being blurred by the overwhelming amount of false, biased and potentially
harmful content about COVID-19 flooding the social media platforms on a
daily. Misinformation pertaining to the coronavirus can have a major
impact on people’s life. Of the videos analyzed in this study, 14.2% discred-
ited medical advice in an attempt to provide a fast, easy cure for the
148 S. SAWANT ET AL.

disease. Such information threatens the lives of people who could poten-
tially take the unprescribed medications suggested in these videos in an
effort to mitigate their symptoms, possibly leading to an increase in the
mortality rate. Misinformation regarding the spread of the virus can also
cause a sense of panic among people and cause them to take unlawful or
drastic actions against someone else on the pretext of that information.
Moreover, many of the viewers on YouTube are minors (Mueller et al.
2020), important because they may find it difficult to differentiate between
valid and misleading content. As a result, they maybe at a higher risk of
falling prey to misinformation given their age. To address this situation,
children must be taught how to discern between misleading and valid
information. The current situation is further exacerbated because of the
uncertainty about who has the expertise to disseminate information regard-
ing this novel coronavirus (Pennycook et al. 2020). Situations like these
generate a sense of confusion among viewers, making them susceptible to
misleading information.

Lower volumes of good and excellent quality content about COVID-19

on YouTube
According to our evaluation using the DISCERN and JAMA quality scales
only 11.7% and 3.3% of the total videos analyzed were of good and excel-
lent quality respectively, containing unbiased, accurate information from a
credible source. Previous studies have also found that the quality of
YouTube videos as a source of information on various medical subjects
was generally low; thus, it is not surprising that our results support these
previous findings (Gokcen, Bahadir Gokcen, and Gumussuyu 2019; Fischer
et al. 2013; Mukewar et al. 2013). YouTube content creators may focus
their attention on posting a specific type of content based on current trends
without regards for the accuracy or reliability of the information to increase
viewers and subscribers, leading to much misleading, false or biased infor-
mation being uploaded.

Higher preference for low quality videos as compared to high

quality content
Informative and factual videos are infrequent, and they do not receive
as many likes, and, hence, appear to be not as popular, compared to the
low-quality videos. The length of the videos can be an important aspect
affecting viewer engagement with videos (Biggs et al. 2013). The mean dur-
ation for the high-quality videos (9 min and 14 s) was higher than for the
low-quality videos (4 min and 42 s). On average a low-quality video
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 149

received four times more views (190,967) than a high-quality video

(46,449), suggesting that the longer high-quality videos may have put off
viewers looking for quick answers. Viewers specifically search for alterna-
tive treatment plans or home remedies, both of which are usually found in
low-quality videos, while academic videos are less exaggerated and, thus,
may fail to attract the attention of the viewers even though they contain
superior quality information (Mueller et al. 2020). Academic videos use
facts and figures obtained from trusted sources to educate people and do
not give out baseless solutions.

Potential interventions to improve the volume and visibility of high quality

content on YouTube
It is evident from the results of this study that the overall quality of videos
on YouTube pertaining to alternative therapies for prevention and treat-
ment of COVID-19 is low and the need for high quality content is indis-
putable. Health information sites, university/academic channels, medical
health agencies and nonprofit organizations should be encouraged to pro-
duce and provide evidence-based and easy-to-understand information
about causes, symptoms, pathology, prevention techniques, social distancing
and preventive care, and the dangers of non-evidence-based treatment
options should be highlighted. To neutralize the widely available misleading
information on YouTube, measures of quality assessment (e.g., DISCERN
system) can be applied prior to the release of the videos on the Internet
(Mueller et al. 2020). Health information seekers tend to view videos that
appear on the first page of the search results (Eysenbach and K€ ohler 2002).
Therefore, placing high quality content in the search results on this page
becomes critical for improving the visibility of useful information and for
ensuring it is widely viewed. YouTube live sessions could also be an
important tool for identifying viewer issues and concerns while maintaining
the necessary norms of social distancing in a pandemic like COVID-19.
Additionally, efforts should be made by the viewers to read beyond the title
of the videos and analyze if they contain current information relevant to
the subject matter: Does the author/uploader of the content have expertise
in the subject being shared? Is the accuracy supported by evidence, research
and sources? What exactly is the purpose of the content?
Artificial intelligence (AI) can be an important tool for helping to
address the spread of misinformation. Machine learning algorithms can be
developed to learn and analyze the data and misinformation spread during
past events and, thus, predict the veracity of particular pieces of informa-
tion. These algorithms could analyze video characteristics such as its
source, the account verification, and the viewer’s sentiments to provide an
150 S. SAWANT ET AL.

estimate of the quality of the information and flag what it has found to be
misleading, false or bias content (Nealon and Quirk 2020). Future research
could focus on developing AI-based recommendation engines that could
improve the visibility of high-quality content on YouTube and provide an
easy path for the users to access useful information.

Study limitations
Despite the use of two quality scales (DISCERN and JAMA) to evaluate a
large number of videos on alternative therapies to prevent or treat COVID-
19, our study, like all research, has certain limitations. Although we
conducted a thorough analysis of the video characteristics, we could not
determine and evaluate the potential association of viewer comments with
the video characteristics like view counts, likes, and dislikes. Viewer com-
ments can be an important aspect for gauging viewer engagement and to
understand viewer sentiments toward the content. This study was con-
ducted during the early stage of the pandemic (April 2, 3, 4, and 11, 2020),
and newer developments are evolving every day pertaining to the COVID-
19 pandemic. Therefore, different search results from a different timeframe
are a possibility. We considered only the top 120 videos based on relevance
and view counts because we were evaluating from the viewpoint of
YouTube users, the majority of whom fall into the non-physician or non-
health professional group who tend to view the information that they
encounter first or that which has been watched by the majority of the pre-
vious viewers. Future studies can evaluate these aspects, perhaps using
novel quality assessment techniques.

Conclusion
The study identified that 55% of the videos analyzed were below medical qual-
ity standards and often contained misleading, false, or biased information. A
good proportion of these misleading videos were marked as having potentially
harmful content. However, a poor correlation between the quality assessment
findings and viewer ratings (likes) was observed. Therefore, the viewer rating
cannot be considered as an accurate estimate of the content quality of the vid-
eos on YouTube. The duration of the videos could be a potential reason for the
viewer’s disengagement from the high-quality videos, which tend to be more
detailed and technical and less exaggerated. It is crucial that future studies
evaluate user sentiments to better understand the lack of association between
user ratings and the quality assessment findings and to improve the quality of
medical information on this powerful platform. With developments made daily
regarding various treatment methods and a vaccination for the novel
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 151

coronavirus, there is a possibility of a surge in the amount of misleading con-

tent being uploaded on the Internet. Therefore, it becomes critical that govern-
ment agencies and medical associations develop new and enhanced
interventions to improve their presence on social media and, thus, improve the
quality standard of the health care information disseminated through
YouTube. Doing so is made even more important today because while this
study focused on COVID 19, its results have implications for the future pan-
demics which will most certainly follow.

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About the authors

Sarvesh Sawant is a doctoral student in the Department of Industrial Engineering at
Clemson University. His research interests are in applying the concepts of human factors
engineering to improve healthcare systems.
Aswathi Nair is a graduate student in the School of Public Health at The University of
Texas Health Science Center. Her research interests addresses topics in telemedicine and
health informatics.
Shaik Aisha Sultana is an anesthesiologist at the Apollo Institute of Medical Sciences with
research interests in public health.
Arjun Rajendran is a senior resident in the Centre for Endocrinology and Diabetes at
Amrita Hospitals. His research interests are in public health, telemedicine, and health
informatics.
 JOURNAL OF CONSUMER HEALTH ON THE INTERNET 155

Kapil Chalil Madathil is the Wilfred P. Tiencken endowed Assistant Professor of Civil and
Industrial Engineering at Clemson University. His area of expertise is in applying the
knowledge base of human factors engineering to the design and operation of human-com-
puter systems.