Video Parameters and Scoring System
The videos included in the study were watched by two independent surgeons, both specialized in endourology. In case of inconsistent evaluation between the two surgeons (non-matching results), a third physician evaluated the videos. In addition, the reactions of the viewers to the videos were assessed by recording the parameters of total views, views/month, and video likes and dislikes. The data were divided into two groups based on the source of upload: Group 1 consisted of healthcare providers (doctors, universities, academic journals, university or non-profit physicians, or professional organizations) and Group 2 comprised commercial companies or for-profit organizations. The presence or absence of commercial bias was evaluated as described by Cornish et al. (8). The degree of misinformation was assessed with reference to currently available evidence on surgical BPH treatment as reported by the EAU guidelines (9). In addition, we rated the extent of misinformation of the videos based on a Likert scale of 1 to 5 (‘none’, ‘low’, ‘moderate’, ‘high’ and ‘extreme’) (10). All videos were systematically evaluated using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT) and the validated DISCERN quality criteria (11–13).
PEMAT is a systematic method developed to select printable and audiovisual patient education materials, which are easier to understand and easier to act on. We used the version for audiovisual materials, which consists of 13 items measuring understandability and four items measuring actionability. The PEMAT provides two scores for each material—one for understandability and a separate score for actionability. Every item have a 1 point (Agree) or 0 points (Disagree) and N/A was not included the calculation. There is no set cut-off value for the scores.
DISCERN is a standardized index of quality of consumer health information on treatment choices, which can be used by anyone without the need for specialist knowledge. The questionnaire consists of a total of 15 items plus an overall quality rating, with each item representing a separate quality criterion rated from 1 to 5 points (1–2 points: low; 3 points: moderate; and 4–5 points: high quality). Thus, a total score of 80 points is possible, with higher scores indicating higher quality. For the purposes of this study, we rated the videos using all relevant items and gave them an overall quality rating although not all the videos were directly concerned with treatment choices.
To determine the overall quality of the videos, the Global Quality Score (GQS), a five-point scale, was used (GQS: 1 = poor quality; 5 = excellent quality). This tool measures the accessibility quality and overall flow of the information contained within a video (14).
JAMA is a scoring system with a total of 4 points scored evaluating whether the authors, institutions, references and sources are clearly stated in the video, whether there is information about copyright, whether there is any clear conflict of interest, and whether the dates of uploading and publication are clearly given (15).