We systematically reviewed YouTube content on gestational diabetes on April 30, 2020. Search terms were identified in consultation with 2 perinatal diabetes care specialists (CN and LY), and Google Trends was used to identify top searches associated with gestational diabetes. The search was then conducted on a cache-cleared web browser using incognito mode with the following terms: “gestational diabetes,” “gestational diabetes management,” “gestational diabetes treatment,” and “pregnancy and diabetes.” The search was conducted via public access—a registered account was not used.

Search results were displayed by relevance, which is the default search setting. The first 60 results—representing the first 3 pages of results—from each keyword search were reviewed and analyzed. The sample size and sort strategy were selected based on research indicating that the majority of internet searchers view only 1 page of results, and 83% of searchers view no more than 3 pages [31]. Duplicate videos, videos unrelated to gestational diabetes, videos in a language other than English, and clips for which the full video was unavailable were excluded.

Descriptive characteristics of each video were collected, including video length, number of comments, channel number of subscribers, number of views, number of likes, and number of dislikes. Collection of this information was completed by 1 reviewer (EB), over the course of 1 week (from April 26, 2020 to May 2, 2020) to minimize variability in number of views and other characteristics collected. Source characteristics were also gathered from each video. These included the video source and whether the video was a character video, which was defined as a video in which a specific, identifiable person was presenting. Video source was determined based on the affiliation of each video’s author when available (eg, identified as an employee of a hospital system or pharmaceutical company), or the channel description and theme (eg, medical school test preparation videos or personal vlog in which the author presents primarily personal experiences).

Criteria to judge video content were formulated from American College of Obstetricians and Gynecologists recommendations for management of gestational diabetes, and in consultation with perinatal diabetes care specialists (CN and LY). Video comprehensiveness and accuracy of information provided about (1) screening or testing guidelines; (2) treatment for gestational diabetes self-management; (3) nutrition information; (4) information about the purpose of gestational diabetes treatment and benefits; (5) blood glucose level monitoring guidelines; (6) gestational diabetes effects on long-term maternal health; and (7) gestational diabetes effects on the fetus. These topics were selected because they represent key foundational knowledge regarding gestational diabetes that is essential for participants to understand their condition, participate in self-monitoring and management, and engage in health care to prevent adverse perinatal outcomes. To evaluate videos, we used a content score—1 point for each content area addressed accurately in the video (ie, the video included relevant information in that topic area, though depth of explanation varied); thus, a maximum score of 7 was possible if a video covered the comprehensive range of topics about gestational diabetes accurately. Similar assessments have been performed in prior evaluations of YouTube videos as a health information source [32-36].

The DISCERN instrument [37] was used to assess the quality and reliability of the videos as information sources. The DISCERN instrument consists of 16 questions assessing the (1) reliability, (2) quality, and (3) overall rating of web-based publications. DISCERN criteria are written as questions and are rated on a scale from 1 (not satisfied) to 5 (fully satisfied). The DISCERN tool has been validated for use in a variety of settings, and it has been used in similar studies that have evaluated YouTube videos as a source of health information [34,35,38-42].

A combination of both scoring techniques was used to divide videos into high- and low-quality categories. Videos with a mean DISCERN score less than 3 or a content score less than 4 were defined as low quality; otherwise, videos were defined as high quality. These quality cutoffs were chosen because they correspond to a DISCERN rating representing potentially important shortcomings or an inclusion of fewer than half of the expert-developed content topics, respectively, both of which affect the overall quality of the video as a reliable comprehensive source of information.

After determining evaluation criteria, 2 videos were assessed collaboratively by 3 reviewers (EB, JJ, ED) to establish consensus on the application of these criteria and scoring. Subsequently, these 3 reviewers independently evaluated the same 15 randomly selected videos for content and reliability. The remaining videos were then divided evenly among the reviewers, and each was evaluated using the established standardized criteria. Data for each video were collected and stored using REDCap (Vanderbilt University) software.

Statistical analyses were performed using Excel software (version 2020; Microsoft Inc). Interrater agreement was analyzed using intraclass correlation coefficients and single-factor analysis of variance. Descriptive statistics were used to evaluate study data. Frequencies were used to describe categorical variables; normally distributed continuous variables were presented as means, and nonnormally distributed variables as medians. The Kruskal-Wallis test for intergroup comparison, Spearman rank correlation, and Wilcoxon rank-sum test were used for analysis involving nonnormally distributed continuous variables. A P value<.05 was considered significant.

This study was deemed exempt from review by the Northwestern University institutional review board because it does not involve human participants.

In this study, we identified no relationship between video quality and indicators of video popularity. These findings indicate that the information available to pregnant individuals with gestational diabetes is highly variable in quality, and may not deliver accurate or comprehensive information to users.

YouTube has been evaluated as a source of health information on a variety of topics, including emerging infectious diseases and pregnancy [43,44], medication use in pregnancy [27], and diabetes outside of pregnancy [34], as well as colorectal cancer [36], ankylosing spondylitis [39], and rheumatoid arthritis [40]. The average DISCERN score in this study is concordant with that found in many previous studies of YouTube videos [34,35,38-40,43]. Scores in previous studies have typically fallen in the low to moderate reliability range, indicating potentially important shortcomings. Although studies evaluating other health conditions used various topic-specific comprehensiveness scales, they found similar levels of topic coverage, accuracy, and comprehensiveness to those found by us [36,40,41]. We found that this level of topic inclusion represents notably incomplete coverage of the health condition. The majority of videos we evaluated covered only 3 to 4 key topics about gestational diabetes accurately, and only 1 topic—gestational diabetes management—was included by more than 50% of videos. The overall low comprehensiveness of individual videos evaluated has implications for their utility as health information resource. In further research, it could be helpful to investigate YouTube user viewing patterns to ascertain whether these shortcomings can be overcome through careful combination of videos and topics covered.

Interestingly, in our study, one of the lowest rated videos overall by both DISCERN criteria and topic coverage had some of the highest views, likes, comments, and channel subscribers. This video was a media clip related to a television personality; therefore, the high numbers of views, likes, comments, and subscribers are likely because viewers accessed the clip for entertainment rather than for information about gestational diabetes. However, this highlights an important aspect of finding health information on YouTube—the search algorithm may not take the quality of the video into account for any specific search term, and quality varies significantly between videos. As we found and as has been seen previously, there are rare videos available with both good reliability and comprehensive topic coverage; however, it is difficult to ensure that these videos are accessed, as they are not necessarily the most viewed, liked, or highly ranked videos available [38,45,46].

Pregnant patients increasingly seek health education via web-based sources, including YouTube, and web-based media can be helpful adjuncts to clinical care [15,17,25,47-49]. Trust in information found on the internet is often reported to be high, and many people who sought information on the internet did not discuss it with their providers [15,17]. Therefore, it is important for providers to be aware of the overall use and limitations of YouTube as a resource when counselling patients with gestational diabetes, and it may be useful for clinicians to query and understand the resources patients are using to augment their clinical care.

However, it is also important to note that YouTube has the potential to address the specific needs of individuals with gestational diabetes. Health information and supportive social networks—which are both easily accessed via the internet—have been found to influence the challenges experienced by people with gestational diabetes [49-51]. In addition, patients’ health literacy levels and access to information are known to affect glycemic control and gestational diabetes–related outcomes [52-55]; interventions for pregnant individuals at an appropriately targeted health literacy level are particularly essential to address health inequities present in gestational diabetes care and outcomes [8,56]. Video-based information has frequently been used to combat care barriers related to health literacy [57-59]. Despite the limitations found in this study, YouTube videos remain a low-cost, easily accessible resource, and further interventions should investigate ways to address these limitations in order to harness YouTube’s potential as a patient education tool. Clinicians also have the opportunity to assist patients who are using YouTube as resource by recommending specific videos, discussing ways to identify reliable resources, or even creating high-quality content. Health care providers involved in gestational diabetes care are likely to have both the knowledge base and the resources available to create accurate comprehensive videos with information that is helpful for patients with gestational diabetes.

To the best of our knowledge, this study is the first to assess the reliability, content, and quality of YouTube videos about gestational diabetes, but it has several limitations. First, while the sample size was chosen to encompass the majority of videos likely to be encountered by individuals searching for information about gestational diabetes, we cannot ensure that all videos that a user may find were included, given the dynamic nature of video uploading. Search history or location may also affect ranking and accessibility of videos in ways that were not demonstrated in this paper. Second, we could not evaluate the target audience for each video, because most videos do not indicate their audience and default search setting will not necessarily preclude people from accessing videos aimed at different groups. As such, our assessment of quality and reliability may not reflect all videos with which pregnant individuals engage. Additionally, our search was limited to English-language videos, and future work is necessary to corroborate our findings with those for videos in other languages.

We also noted little gender, racial, or ethnic diversity among YouTube presenters in videos about gestational diabetes. Especially because social media sites, and YouTube specifically, may be sought as a more personal or personal-experience based resource, this lack of diverse representation is a noteworthy limitation. Based on the representation found in the videos evaluated, many patients may not see themselves or their experiences reflected fully.

Despite the relatively low quality and comprehensiveness found among YouTube videos for individuals with gestational diabetes, YouTube is an easily accessible and increasingly important source of health information. Providers caring for individuals with gestational diabetes should remain aware of the limitations of this resource, especially when discussing information sources with patients. Further study may be helpful in elucidating ways to harness the potential strengths of YouTube for providing high-quality accessible health information.