Introduction
The evaluation of the quality of information (QOI) contained within oral health-related videos on the video-streaming Web site YouTube has been limited. This study aimed to determine the QOI regarding orthodontic retention and retainers contained within videos uploaded by dental professionals (DPs) to YouTube.
Methods
YouTube was systematically searched using 4 terms. The top 50 videos per search term by “number of times viewed” were stored in a specially created account. Following the application of inclusion/exclusion criteria, the videos were assessed for viewing characteristics, and a 4-point scoring system (0-3) was applied to evaluate QOI in 10 predetermined domains. Descriptive statistical analyses, intrarater, and interrater reliability tests were performed.
Results
Strong intrarater and interrater reliability scores were observed. Sixty-two videos from the top 50 most-viewed DPs were viewed a total of 1,367,810 times (range 77- 529,543). Most DPs originated from the United States (68%), and orthodontists (88%) uploaded most videos. The mean number (standard deviation [SD]) of reported domains was 5.5 out of 10 (SD, 2.2). The mean overall QOI score per domain was 1.14 out of 3 (SD, 0.64). The “importance of retention” domain scored highest (2.18; SD, 1.2). “The need for retention reviews” domain scored the lowest (0.3; SD, 0.65). The mean overall QOI score per DP was 11.72 out of 30.00 (SD, 5.85).
Conclusions
The QOI related to orthodontic retention and retainers contained within videos provided by DPs through the YouTube Web site is deficient, particularly the need for retainer review. Orthodontists should be aware of the importance of YouTube as an information resource and ensure that videos related to orthodontic retention and retainers contain relevant, high-quality, and evidence-based information.
Highlights
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The Internet has become a popular source of health information for patients.
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Videos uploaded to YouTube by dental professionals were identified
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Information about retention and retainers in the most-viewed videos was evaluated.
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The quality of the information provided by dental professionals was found to be deficient.
Internet use is increasing, with over 80% of the U.S. population having access to the World Wide Web via a subscription service. The Internet is a provider of easily accessible information and has become a popular source of health information for the general public. , The National Health Interview Survey found up to 66% of the population has used the Internet for health information. In addition, over 30% of dental patients have researched their presenting dental condition online or had a family or friend research their condition on their behalf.
The video-streaming Web site, YouTube, is the third “most visited” Web site in the world and is one of the most popular websites for patients wishing to access medical information. , Videos can be uploaded by any individual or organization and are freely available through a wide range of media platforms such as personal computers, tablets, smartphones, and televisions. Videos can be easily sourced by the use of search terms and viewed after that. Health information found on YouTube is not generally subject to regulation or peer review and, as a consequence, may lead to the placement and availability of erroneous information. ,
Medical and dental professionals (DPs) recognize the influence of YouTube as an information resource for patients and the general public, and several studies have evaluated the quality of available material. The quality of information (QOI) related to many medical conditions and treatment procedures is variable with some videos presenting misleading and even potentially dangerous information. , ,
Studies evaluating the “completeness” and quality of oral health-related videos on YouTube have shown, for example, that information on dental implants, endodontic treatment, and oral cancer vary in quality. The investigation into the quality of orthodontic information on YouTube has been limited. Researchers have found the QOI of videos related to lingual orthodontics and orthognathic surgery available on YouTube to be substandard. , A significant majority of studies, however, have evaluated videos uploaded from a variety of sources—not those uploaded from health professionals only.
It is essential that current and potential orthodontic patients are fully informed regarding all of the risks related to orthodontic treatment. Orthodontic treatment usually requires wear of an orthodontic retainer and adherence to a retention protocol to minimize the risk of postorthodontic treatment relapse. , A recent qualitative study, which was linked to a randomized control trial comparing the effectiveness of bonded retainers and vacuum-formed retainers, has revealed the potential importance of YouTube. , A significant number of participants who had completed orthodontic treatment, particularly those lacking long term retainer follow-up, frequently referenced YouTube as a valuable source of relevant information. One potential mechanism, therefore, to effectively communicate reliable, evidence-based information regarding retention and retainers may be via videos uploaded by DPs, national orthodontic societies, and dental educational facilities.
Currently, however, there appears to be little published information regarding the QOI of orthodontic retention and retainers contained within YouTube videos. The aim of the present study, therefore, was to evaluate the QOI regarding orthodontic retention and retainers presented within the videos uploaded to YouTube by DPs.
Material and methods
Ethical approval was not required for this study because it only evaluated publicly available data.
The methodology used to determine the QOI was adapted from similar investigations into oral health-related videos uploaded to YouTube. ,
The online video hosting resource YouTube was searched in November 2018 for videos containing information relevant to orthodontic retention and retainers. The following keywords and/or search terms were used: “Clear retainers,” “Orthodontic retainer,” “Retainer,” and “Orthodontic retention.”
The following were the inclusion criteria: (1) content in the English language, (2) videos identified as “belonging” to a DP, (3) primary content related to orthodontic retention, and (4) acceptable audio-visual quality.
The following were the exclusion criteria: (1) videos lacking audio or visual content, (2) videos exceeding 15 minutes in length, (3) humorous and drama-based videos, and (4) news stories.
The top 50 videos from each search term were stored and saved in a specially created YouTube account. Each video was assessed according to the inclusion and exclusion criteria and then ranked using the YouTube advanced search option “sort by view-count.” The videos were subsequently evaluated according to the individual DP source. More than one video per DP was assessed as “one video.” The evaluation continued until videos from the top 50 DPs by “view-count” were evaluated.
All videos were viewed in their entirety, and the following were recorded for each: (1) clinical source, (2) country of origin, (3) number of views, (4) time elapsed since upload, (5) duration, and (6) total number of “likes” and “dislikes.”
The audio and visual quality of the videos was scored on a scale of “good,” “fair,” or “poor.” , Ten orthodontic retainer and retention-related domains were identified from publicly available relevant information resources from the American Association of Orthodontists and the British Orthodontic Society ( Table I ). , The presence, or not, of each domain, was recorded. The QOI contained in each domain present in the video was then assessed using a 4-point score ( Table II ). For example, mention of a bonded retainer and at least 2 removable retainers elicited a score of 3 points for the domain, “What are the different types of retainers?”
| Domains |
|---|
| What is a retainer? |
| What are the different types of retainers? |
| Why is it important to wear a retainer? |
| What are the advantages and disadvantages of the different types of retainers? |
| How long will a retainer have to be worn? |
| What is the “daily removable retainer wear” protocol? |
| What do I do if my retainer breaks or is lost? |
| How might a retainer affect me (“quality of life”)? |
| How often will I need to be reviewed? |
| How do I care for my retainer? |
| Score | Comment |
|---|---|
| 0 | Video contains no and/or misleading information |
| 1 | Video contains inadequate information |
| 2 | Video contains adequate information |
| 3 | Video contains excellent and comprehensive information |
Each video, therefore, could achieve a total maximum score of 30 points, which would indicate comprehensive and scientifically valid information on all evaluated domains. A score of zero points for a domain would indicate absent or inaccurate information for that domain.
Statistical analysis
All data were recorded independently by the 2 evaluators (M.J.M. and P.S.) in Microsoft Office Excel (Microsoft Corporation, Redmond, Wash) and descriptive statistics calculated from IBM SPSS Statistics for Windows (version 25; IBM Corp, Armonk, NY). Cohen kappa coefficient was used to examine intrarater and interrater agreement for the presence of information and the QOI.
Results
Following the application of exclusion and inclusion criteria, the videos of the top 50 DPs per “number of times viewed” were assessed ( Fig 1 ). Sixty-two videos had a total of 1,367,810 views with a mean number of views of 27,356 (standard deviation [SD], 81,191) per DP ( Table III ). Orthodontists provided the most videos (88%), and the U.S. (68%) was the country of origin of most DPs. The visual quality of the videos was good (62%) or fair (34%), with only 4% deemed poor. Regarding audio quality, 78% of videos were assessed as good, 20% fair, and 2% poor. Figure 2 shows the number of the orthodontic retainer and retention-related domains reported by the DPs. The mean number of domains reported by each DP was 5.5 (SD, 2.2), with only 1 DP reporting all 10 domains. “What is a retainer?” (88%) and “Why is it important to wear a retainer?” were the most commonly reported domains ( Fig 3 ). Twelve videos (24%) indicated that retention was indefinite. The mean overall QOI score per domain was 1.14 out of 3 (SD, 0.64). Table IV shows “the importance of orthodontic retainers and retention” was the domain that scored most highly for QOI (2.18; SD 1.2), and “the need for retention and retainer review” scored the lowest (0.3; SD 0.65). The mean overall quality score per DP was 11.72 out of 30.00 (SD, 5.85; range, 0-24). Figure 4 shows the overall QOI scores among DPs. Cohen kappa intrarater and interrater agreement for the presence of information (0.86 and 0.85) and QOI (0.84 and 0.82) were strong.
| Variable | Min | Max | Mean (SD) | Total (n) |
|---|---|---|---|---|
| Video characteristics | ||||
| No. of views | 77 | 529,543 | 27,356 (81,191) | 1,367,810 |
| No. of likes | 0 | 1100 | 75.60 (207.59) | 3780 |
| No. of dislikes | 0 | 63 | 5.24 (11.78) | 262 |
| Duration, s | 17 | 750 | 172.4 (154.57) | 8620 |
| Months since upload | 3 | 124 | 49.24 (31.82) | 2462 |
| Uploader characteristics | ||||
| DP | ||||
| Orthodontist | 44 | |||
| Dentist | 5 | |||
| Myofunctional therapist | 1 | |||
| Country of origin | ||||
| United States | 34 | |||
| United Kingdom | 10 | |||
| Australia | 2 | |||
| Others/indeterminate | 4 |
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