DIAB-6451; No. of Pages 4 diabetes research and clinical practice xxx (2015) xxx.e1–xxx.e4 Contents available at ScienceDirect Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres YouTube as a source of useful information on diabetes foot care Tasnima Abedin a, Salim Ahmed a, Mohammad Al Mamun b, Syed Walid Ahmed a, Sanjida Newaz a, Nahid Rumana c, Tanvir C. Turin a,* a Department of Family Medicine, University of Calgary, Calgary, AB, Canada Department of Public Health, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Tabuk, Kingdom of Saudi Arabia c Sleep Center, Foothills Medical Center, University of Calgary, Calgary, AB, Canada b article info abstract Article history: Diabetes foot care related videos were identified in YouTube to assess their usefulness as a Received 28 June 2015 source of information. Two physician reviewers evaluated the videos and categorized those Accepted 3 August 2015 as very-useful (11.2%), moderately-useful (14.6%), somewhat-useful (24.7%) and not-useful Available online xxx (49.4%). YouTube videos on diabetes foot-care contained a variety of content ranging from very useful to not useful. # 2015 Elsevier Ireland Ltd. All rights reserved. Keywords: Diabetes Foot-care YouTube Video 1. Introduction Diabetes is a very common disease worldwide with the projection of 592 million or 10% world’s total population will suffer diabetes by the year 2035 [1]. Long-term diabetes patients are more likely to develop peripheral neuropathy. Due to the nerve damage and poor blood circulation to the legs and feet it is hard for diabetes patient to feel pain in the wounded area. Unnoticed or untreated foot injuries or wound can quickly become infected and may lead to serious complication like foot ulcer and foot gangrene. Foot complications from diabetes are one of the major cause of amputation which causes prolonged hospitalization, decrease quality of life and creates burden on the family [2]. Therefore proper foot care education is very important for diabetes patients. Over the past few years social media has gone far away from just being a platform to connect people. Social networking sites (such as Facebook, YouTube and Twitter) are creating a new dimension in disseminating health related information [3–5]. YouTube is a free online video-sharing social media website with more than 1 billion users where individuals are able to watch, share and upload videos [6]. However like other social networking sites, YouTube also has the risk providing inaccurate or misleading information that contradict the reference standards. In this study we looked into the effective use of You Tube as a source of information on diabetes foot care. 2. Research design and methods YouTube (www.youtube.com) was searched on March 12, 2015 using the key word ‘‘diabetes foot care’’. The search resulted about 26,700 videos. We considered videos from first five pages assuming that users are less likely to go beyond the first five pages for a specific search term. We also excluded non-English * Corresponding author. Tel.: +1 403 210 7199; fax: +1 403 210 9180. E-mail address: turin.chowdhury@ucalgary.ca (T.C. Turin). http://dx.doi.org/10.1016/j.diabres.2015.08.003 0168-8227/# 2015 Elsevier Ireland Ltd. All rights reserved. Please cite this article in press as: Abedin T, et al. YouTube as a source of useful information on diabetes foot care. Diabetes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.diabres.2015.08.003 DIAB-6451; No. of Pages 4 e2 diabetes research and clinical practice xxx (2015) xxx.e1–xxx.e4 Table 1 – Criteria checklist for usefulness and source of You Tube video on diabetes foot care. Usefulness criteria 1. Checking feet daily 2. Washing feet everyday 3. Drying feet properly 4. Moisturizing feet properly 5. Cutting nails carefully 6. Wearing proper shoes and socks 7. Protecting feet from hot/cold 8. Awareness about self-treatment of corn/calluses 9. Annual checkup by professional healthcare provider 10. Awareness about bad effect of smoking 11. Taking care of blood glucose level Upload source criteria 1. Organization: If the video was uploaded by any organization 2. Professional: If health care professionals like podiatrist, nurse or doctors uploaded the video 3. Personal: If someone with unknown credentials uploaded the video 4. Advertisement: If the video was uploaded in intension of selling products or service Fig. 1 – Process of including You Tube videos on diabetes foot care for the analysis. videos and videos over 30 min assuming that users would not have patience to watch a video for more than 30 min (Fig. 1). URLs of all the selected videos were recorded for assessment by the reviewers. We created an 11-point information checklist (Table 1) for evaluating usefulness of the videos based on available literature [7–10] and categorized those checkpoints into 4 groups of usefulness: Very useful (8–11), moderately useful (4–7), somewhat useful (1–3), and not useful (0). Other relevant information such as views, duration, likes/ dislikes, number of comments and source were also recorded. Source of the video was further categorized into 4 groups: Professional, Personal, Organization and Advertisements (Table 1). Two physician reviewers (S.W. and S.N.) independently assessed each video and classified them accordingly. Any disagreement between reviewers was solved by discussion. Inter-reviewer agreement was determined by kappascore. Descriptive statistics were given for all variables. Differences in continuous variables among the groups were tested by ANOVA or Kruskal–Wallis test as appropriate. Categorical variables were also tested using the Chi-squared test. A p value of less than 0.05 was considered as significant. All statistical analyses were done of SPSS version 20 (IBM Corporation). 3. Results According to our inclusion criterion 89 videos were finally considered for extracting information (Fig. 1). Total length of the videos were 291.61 min and total number of views were 613,445. Total number of likes, dislikes and comments were 687, 98 and 278, respectively. Among the 89 videos 11.2% were categorized as very useful, 14.6% were categorized as moderately useful, 24.7% were categorized as somewhat useful and 49.4% were categorized as not useful. Table 2 shows the video characteristics across different level of usefulness category. There were significant difference in median number of likes (Chi-square = 11.345, p value = 0.010), median length of videos (Chi-square = 22.51, p value < 0.001) and median number of views (Chisquare = 11.98, p value = 0.007) among the 4 different levels of usefulness. No significant differences were found in median number of dislikes and median number of comments for usefulness of videos. Fig. 2 shows the sources of videos by level of usefulness. There was a significant difference between the usefulness of videos and sources of the videos (Chi-square = 60.83, p value < 0.001). Majority of the very useful videos (n = 5; Table 2 – Descriptive statistics by level of usefulness. Level of usefulness of the n (%) Likes, mean (sd) Dislikes, mean (sd) Comments, mean (sd) Length of video, mean (sd) Number of views, mean (sd) p Value Very useful Moderately useful Somewhat useful Not useful 10 (11.2%) 19.90 (39.57) 2.10 (4.28) 5.50 (9.62) 6.97 (2.58) 17,400.3 (32,916.97) 13 (14.6%) 7.08 (12.33) 0.38 (0.77) 1.85 (4.00) 3.23 (1.32) 6909.15 (20,214.49) 22 (24.7%) 3.91 (7.10) 0.32 (0.78) 1.23 (3.15) 3.20 (5.74) 2853.39 (5219.21) 44 (49.4%) 7.05 (25.89) 1.48 (5.97) 3.91 (14.97) 2.49 (2.55) 6519.30 (27,273.17) – 0.010 0.498 0.337 <0.001 0.007 * sd = standard deviation. Please cite this article in press as: Abedin T, et al. YouTube as a source of useful information on diabetes foot care. Diabetes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.diabres.2015.08.003 DIAB-6451; No. of Pages 4 diabetes research and clinical practice xxx (2015) xxx.e1–xxx.e4 e3 Fig. 2 – Level of usefulness across source of the videos. Striped bar: represents not useful videos; black bar: represents very useful videos; grey bar: represents moderately useful videos; dotted bar: represents somewhat useful videos. 5.6%) were uploaded by professionals, whereas most of the not useful videos (n = 40; 44.9%) were advertisement. The top two diabetes foot care practice mentioned in videos were ‘‘checking feet daily’’ (n = 34; 38.20%) and ‘‘wearing proper shoes and socks’’ (n = 26; 29.21%). Inter-reviewer reliability was found 82.6% (Kappa score 0.826). 4. Discussion YouTube is one of the major social network sites where users can share videos at free of cost and can communicate easily with viewers. Since YouTube users are from different ages and backgrounds, it is necessary to understand it’s effectiveness in providing health awareness among users. Studies have done using YouTube contents for various diseases [4,10–16]; however to the best of our knowledge, this is the first study on analyzing the usefulness of YouTube video on diabetes foot care. We found that ‘‘very useful’’ and ‘‘moderately useful’’ videos were demonstrated by professional podiatrists and nurses. Very useful videos contained elaborate information on diabetes foot care and had highest number of views, likes and comments. Most of the advertisements contained nonuseful information except 14.6% contained somewhat useful information. This 14.6% was provided by podiatrists or foot clinics. Only 10.1% of the total videos were from personal sources suggesting that the idea of diabetes foot care is not very popular among general population. We found only 2.2% of the very useful videos were uploaded by organizations. It would be beneficial for diabetes patients if the international organizations such as International Diabetes Federation or World Health Organization would take part in creating elaborate, easy and patient engaging videos about diabetes foot care. This study has few limitations. First, the usefulness criteria were subjective. Second, our study is specific for a time period and search words. Third, we only included English language videos and videos that are less than 30 min of length. In conclusion, this study shows that YouTube has quite a large number of videos on diabetes foot care with content ranging from very useful to not useful. A very small number of these videos were considered as very useful which suggests that YouTube, despite its huge potential as health information dissemination platform, cannot be deemed as a good source of useful information on diabetes foot care. Considering the growing popularity and easy accessibility of YouTube, different organizations should come forward to contribute in making authentic videos on proper diabetes foot care. Conflict of interest statement None. Please cite this article in press as: Abedin T, et al. YouTube as a source of useful information on diabetes foot care. Diabetes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.diabres.2015.08.003 DIAB-6451; No. of Pages 4 e4 diabetes research and clinical practice xxx (2015) xxx.e1–xxx.e4 references [9] [1] International Diabetes Federation. Annual report 2013; 2013. [2] Tennvall GR, Apelqvist J. Prevention of diabetes-related foot ulcers and amputations: a cost-utility analysis based on Markov model simulations. Diabetologia 2001;44:2077–87. [3] Al Mamun M, Ibrahim HM, Turin TC. Social media in communicating health information: an analysis of Facebook groups related to hypertension. Prev Chronic Dis 2015;12:E11. [4] Garg N, Venkatraman A, Pandey A, Kumar N. 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YouTube as a source of useful information on diabetes foot care. Diabetes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.diabres.2015.08.003