|Year : 2014 | Volume
| Issue : 7 | Page : 291-294
Utilization of youtube as a tool to assess patient perception regarding implanted cardiac devices
Kevin Hayes1, Prajeena Mainali2, Abhishek Deshmukh1, Sadip Pant1, Apurva O Badheka3, Hakan Paydak1
1 University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
2 Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, USA
3 Wayne State University, Detroit, Michigan, USA
|Date of Web Publication||18-Jul-2014|
University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
Source of Support: None, Conflict of Interest: None
Background: The outreach of YouTube may have a dramatic role in the widespread dissemination of knowledge on implantable cardioverter devices (ICD). Aims: This study was designed to review and analyze the information available on YouTube pertaining to implantable cardiac devices such as implantable cardioverter defibrillators (ICDs) and pacemakers. Materials and Methods: YouTube was queried for the terms "ICD", "Implantable Cardioverter Defibrillator", and "Pacemaker". The videos were reviewed and categorized as according to content; number of views and "likes" or "dislikes" was recorded by two separate observers. Results: Of the 55 videos reviewed, 18 of the videos were categorized as patient education, 12 were advertisements, 8 were intraoperative videos documenting the device implantation procedures, 7 of the videos were produced to document personal patient experiences, and 4 were categorized as documentation of a public event. 3 were intended to educate health care workers. The remaining 3 were intended to raise public awareness about sudden cardiac death. The videos portraying intraoperative procedures generated the most "likes" or "dislikes" per view. Conclusion: While YouTube provides a logical platform for delivery of health information, the information on this platform is not regulated. Initiative by reputed authorities and posting accurate information in such platform can be a great aid in public education regarding device therapy.
Keywords: Health, Implantable cardioverter device, Internet, Youtube
|How to cite this article:|
Hayes K, Mainali P, Deshmukh A, Pant S, Badheka AO, Paydak H. Utilization of youtube as a tool to assess patient perception regarding implanted cardiac devices. North Am J Med Sci 2014;6:291-4
|How to cite this URL:|
Hayes K, Mainali P, Deshmukh A, Pant S, Badheka AO, Paydak H. Utilization of youtube as a tool to assess patient perception regarding implanted cardiac devices. North Am J Med Sci [serial online] 2014 [cited 2019 Nov 16];6:291-4. Available from: http://www.najms.org/text.asp?2014/6/7/291/136899
| Introduction|| |
Patients are increasingly using the Internet to gain understanding into their disease processes, to research treatment options, and to aid in their health care decision-making. Pare et al., reported a dramatic increase in the number of adults in the United States using the internet to obtain healthcare information: 53% in 2005-71% in 2007.  This trend is likely to continue as the Internet increasingly permeates day-to-day life.
One of the more popular websites used for information sharing is YouTube™. This website, which is owned by Google Inc., is an open-access site where registered users can upload video content. Other users can easily search these videos for content of interest. Users then have the option of opining whether they like or dislike a particular video by clicking corresponding buttons. Sites such as YouTube represent a powerful tool for the dissemination of information in many formats ranging from personal experiences to professionally made educational material. Unfortunately, though, there is no quality control measure for the information available, and users are often oblivious to the accuracy of the content. As our patients are increasingly turning to the Internet to research health care information, we as a profession must be aware of the content readily available to them.
This study was designed to review and analyze the information available on YouTube pertaining to implantable cardiac devices such as implantable cardioverter defibrillators (ICDs) and pacemakers.
| Materials and Methods|| |
YouTube search engine was queried on November 28 th , 2011 for three search terms: "ICD", "Implantable Cardioverter Defibrillator", and "Pacemaker". The results were then organized in descending order by the number of "views" and two independent physicians reviewed the first 10 pages of results. The reviewers excluded non-medical videos, videos in languages other than English, and videos beyond the tenth page of results. This yielded a total of 55 videos selected. This process has been illustrated in [Figure 1].
The video clips were categorized into seven categories based on their content: patient education, advertisements, intraoperative videos, personal patient experiences, documentation of a public event, health care worker education and public awareness. Parameters such as number of views, duration of the video, and opinion of the viewers in the form of "likes" and "dislikes" were also recorded.
Analysis was done using SPSS version 17 (SPSS Inc., ChicagoIll). Measures of central tendencies mean and mode were used to express descriptive statistics.
| Results|| |
Of the 55 videos reviewed, 18 [Figure 2] were categorized as "patient education". These were created by professional societies, individual physicians, hospitals, or governmental agencies and were intended to educate patients on the indications for device therapy, what to expect on the day of the procedure, and how to care for the device following the procedure. On average, these videos were viewed 23,425 times [Figure 3] and generated 16 "likes".
"Advertisements" comprised 12 of the 55 videos reviewed [Figure 2]. Individual physicians or hospitals created the majority of these videos, although one was from a lawyer advertising for faulty leads. There were an average of 17,265 views [Figure 4] generating an average of 7 "likes".
Eight of the 55 videos were categorized as "intraoperative documentation" [Figure 2]. These were all videos recorded in the electrophysiology lab during the actual procedure. On average, these videos were viewed 12,172 times [Figure 3] and generated a mean of 13 "likes".
There were seven videos classified as "personal experience" [Figure 2]. These videos were created by patients and served as mini-documentaries of their preoperative and postoperative course. Most of them focused on the healing process and, in particular, the bruising over their device pockets. These were viewed 9347 times (mean number of views) [Figure 3] and generated 3 likes.
Four videos were classified as "public event" [Figure 2] and consisted of video documenting sudden cardiac death of people in public. These videos were by far the most viewed, with an average of 164,855 views [Figure 3]. They were also the most emotionally provocative, generating on average 190 "likes".
Three videos were classified as "health care worker education" [Figure 2]. These videos were created in order to improve the care of patients with cardiac devices and were targeted specifically towards nursing care. They were viewed 9,883 times [Figure 3] (mean no. of views) and generated only 1 "like".
The remaining two videos were classified as "public awareness" [Figure 2]. They served to increase the public's awareness of sudden cardiac death and early management for bystanders. These were viewed, 24438 times (mean number of views) [Figure 3], and generated 11 "likes".
There was one particular video involving sudden cardiac death of a soccer player during a match that was viewed 474,426 times. This video also generated 492 "likes" and 14 "dislikes", attesting to its emotionally provocative material. Only one video showed a successful ICD defibrillation and was viewed 178,175 times, generating 263 "likes" and 5 "dislikes". None of the videos reviewed were found to have inaccurate information. The interobserver agreement was 80% with a kappa coefficient of 0.67.
| Discussion|| |
When first diagnosed with a disease or when contemplating treatment options, more and more patients are turning to the Internet as a means of researching health information. The available websites are vast and the quality of the information on these websites is variable. YouTube is consistently ranked third among the most visited websites across the globe.  It is increasingly used as a means of disseminating information and has powerful implications for educational purposes. According to press-release statistics, over 4 billion videos are viewed each day.  The website design allows for intuitive control and ease when searching for content. An embedded counter automatically tallies the number of times a particular video is viewed. Users are then further able to opine their favorability or distaste of a video by clicking the "like" or "dislike" button. With these simple metrics, one can rapidly discern which videos on a particular topic are popular and which ones are emotionally provocative. When translated into the realm of healthcare information, patients are literally telling us what type of content they desire to see.
In the present study, we focused on cardiac devices. Prior studies have looked at the quality of information related to acute myocardial infarction  and tobacco or hookah use.  Others have looked to YouTube as an educational resource for topics such as breast-feeding  , basic life support  , anatomy , , renal physiology  , pandemic flu  and immunization  YouTube videos have even been used in the treatment of dementia. 
From our data, we can see that there are many videos available on YouTube related to implantable cardiac devices. We can also see that the videos are created for a variety of purposes. What stands out is the large number of people that are drawn to the tragic videos portraying sudden cardiac death. One would expect these videos to elicit the greatest emotional response, however it is actually the videos portraying intraoperative procedures that generated the most "likes" or "dislikes" per number of views [Figure 3]. This indicates that people are very interested in seeing the actual procedure being performed.
Adult Learning Theory tells us that adults learn in a different manner than teenagers or children. The adult learner is independent and self-directed, relies on his or her life experiences to assimilate knowledge, is problem-centered, is most interested in the immediate application of knowledge, and is motivated to learn by internal factors.  Websites such as YouTube seamlessly fit into the Adult Learning Theory. Here, adults are free to direct the content of their education and to do so on their own timetable. Since most patients have no experiences with implantable cardiac devices, they can use video clips from others' experiences to further their own understanding of the problem at hand. It is therefore understandable that adult learners would want to see experiences (ICD shocks, sudden cardiac death, or intra-operative videos) rather than just educational content.
It is notable that we did not see any videos produced by the American Heart Association (AHH), the American College of Cardiology (ACC), or the Heart Rhythm Society (HRS). The only professional Cardiology society represented was the Canadian Cardiovascular Society.
This was a cross sectional study based on content available on YouTube on the date the website was accessed. This website receives some 60 hours of contest every minute from its users - that's roughly 8 years' worth of video every day.  This result in extremely dynamic video database that changes on a minute-to-minute basis. Therefore, the search results analyzed during this assessment were fleeting. As users are able to filter the results based on a number of metrics, it is also likely that a different filter would yield dramatically different results.
There is no way to ascertain the demographics of the viewers used in our analyses. It is unlikely that lay people would be interested in search terms such as "ICD" or "pacemaker", but some of these videos may have been tagged to result with other queries. We therefore can assume that a large proportion of the viewers in our study were patients, potential patients, or family members of patients.
Professional physician societies such as the AHA, ACC, and HRS have a large internet footprint that was not evaluated during this study. It is entirely possible that these societies also have a presence on YouTube, but were simply not included in the search results analyzed.
| Conclusion|| |
YouTube was originally designed as a social, video sharing website. Due to its enormous success, however, it has become a default repository of knowledge that is easily accessible from any internet-connected device. As it becomes increasingly integrated into our portable computing devices, its role in our common experience will only increase. The amount of information related to health care will only increase, as will the number of people who access that content while trying to self-educate about their healthcare issues. Our professional physician societies should embrace this revolution in direct-to-patient education. By utilizing studies such as this one, these societies will be able to create educational videos that satisfy patients' desires for experiential as well as content oriented learning.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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