Colorectal cancer ranks as the fifth leading cause of cancer death among both male and female in mainland China. Because the population of China accounts for one fifth of the global world, colorectal cancer cases in China account for 22% of all newly diagnosed cases and 27% of all deaths from worldwide . The effectiveness of prevention, early detection, and management of colorectal cancer is not only important for China but also for the world.
Internet video websites can provide useful diagnostic, treatment and preventative medical services information. Previous research has evaluated YouTube as an important source of information on disease topics . Although YouTube is blocked due to many reasons in mainland China, there are many similar internet video websites delivering the same functionality, such as Youku. To the best of our knowledge, no study has been performed to assess the accuracy and usefulness of internet videos as a source of healthy information for colorectal cancer in mainland China.
In this study, we selected Youku.com as the target video website, which is ranked the largest Chinese video broadcast site. The website of Youku not only focuses on professionally produced videos but also emphasizes user-generated content. The monthly unique visitors of Youku were 2,6376,000,000 according to the data of October in 2016 .
Our study demonstrates approximately 242 videos addressing colorectal cancer were provided by different sources. Independents users represent the greatest number of sources. The content was mainly about personal experiences in surgical procedures or hospital stays. Our results also show that Chinese medical doctors and health related institutions comprising 17% of colorectal cancer videos do not pay sufficient attention to the platform for the distribution of information. Doctors in china frequently experience work overload, tend to work overtime and experience energy deficiencies, which seem to be one of reasons for this phenomenon . The videos that were viewed most often were the videos posted by doctors followed by health information websites. This indicates that people are more interested in a professionals experience regarding disease rather than their peers.
As the content of most videos often lacks peer or institutional quality review, many may not be subject to quality controls and may not be evidence-based; thus, it is not surprising that a majority of this content is misleading or irrelevant. According to previous studies, the dissemination of inaccurate information by video websites differs from diseases. A total of 56.5% of the video information on cholecystolithiasis , 16.2% on H1N1 influenza  and 1.6% on acute appendicitis in children  on YouTube were misleading. In our study, it was demonstrated that only one-fifth of website videos contain no scientifically oriented information. Only 36% of the independent users videos reviewed were considered to be useful compared with 90% useful doctors’ videos.
The most commonly watched videos from independent users were those that contained misleading information, while the lowest number of views were from medical doctors and health information websites. These results also indicated that effective regulatory measures are needed to control scientifically accredited information. If misleading videos were less viewed by audiences, the harm might be reduced.
Regarding videos addressing colorectal cancer, it is highly difficult for laypeople or patients to distinguish between useful videos or those containing no accurate information. Our result indicates that an important element to assess the reliability of videos regarding colorectal cancer may be the ownership. If academic institutions represent the source, such as hospital/university or medical doctors, the videos may be regarded to be trustworthy on the basis of content . The result is similar to those of other studies conducted outside of mainland China [15, 16].
We found that the average completeness scores were only 18% with a combination of aetiology, anatomy, symptoms, preventions, treatments and prognosis. Most of the included website videos only contained one of the above-mentioned categories. In all of the categories, treatments were the most frequently covered topic (70%). It is unlikely to expect all videos to comprehensively cover all aspects of colorectal cancer; therefore, it should be deemed that some videos, whilst incomplete, do contain precise and valuable content. Our results indicated that videos from medical doctors and health related institutions have significantly higher completeness scores than those posted by independent users. This result may suggest that videos posted by layperson mainly aim a more social goal and videos posted by health and medical organizations commonly take a more educational purpose. The study indicated that professionals should utilize their expertise and contribute to more high-quality videos for patients as information sources in mainland China.
When video contents were analyzed, the most universal topic were the treatment aspects of the colorectal cancer. This finding may indicate that most publishers thought that treatment factors are the most important component of colorectal cancer. Surgery, chemotherapy and radiotherapy have been the mainstay of colorectal cancer treatment. Approximately 70% of videos contained one of the above subjects. As the country of origin and application of TCM, China has a unique TCM theoretical system and effective treatment methods. In mainland China, TCM has been recognized as additional treatment methods for colorectal cancer . Our study shows that approximately 128 videos were about the anticancer properties of traditional Chinese medicine.
In oncology, TCM is believed to have great healing properties such as exerting specific anticancer activity or chemosensitisation to help in the individualization of anticancer treatment [21, 22]. Chinese cancer patients frequently believe that herbs of TCM can help them against suffering from complications and to live well. Doctors trained in Western medicine published fewer videos than doctors trained in Chinese medicine. However, 30% of TCM videos contained misleading information that exaggerated actual effects and propaganda error messages, such as curing colorectal cancer. The highest total and misleading number of videos were posted by independent users. The meanest viewership was also from independent users. The misleading rate was higher than total misleading rate (21%). There have been a large number of controlled clinical studies published in Chinese literature, but high-level evidence for the clinical efficacy of TCM is still lacking . Mistakes were often found in professorial papers and in internet videos.
Colorectal cancer is characterized by high prevalence, a long asymptomatic period and eminently treatable precancerous lesions which, taken together, suggests that screening is a prudent option in mainland China . For this reason, facilitating the earlier diagnosis of colorectal cancer may have a more immediate impact on the existing cancer burden in mainland China. A total of 21 videos contained colorectal cancer screening, which represented only 15% of all useful videos. Almost all screening videos address the importance of a Faecal Occult Blood Test, digital rectal exam, and colorectaloscopy.
Despite the rising colorectal cancer incidence, public awareness is still low in mainland China. Chinese internet websites, such as Youku, provide a different medium to disseminate colorectal cancer information to the public by video instead of written text. The written healthy information is commonly at a considerably higher reading level for Chinese patients. This video-based information source can help them and their caregivers get better understanding. Use of the internet for colorectal cancer information is likely to increase. It is necessary that professional individuals and academic institutions adapt to the advanced technology and think useful methods to solve the variable quality of information uploaded on internet video websites in mainland China. To maximize the potential of video-based information and minimize the quantity misleading or unhelpful information, multilateral efforts between doctors, governments and websites are needed.
First, the main bias of our study was the subjectivity of judgement. There were no validated tools for assessing video data. Therefore, our classification method was subjective. However, the kappa statistic indicated quite high agreement between two reviewers. Second, there was no website, such as YouTube, with a clearly dominant position in China. Selecting only one Chinese video website’s data may lead to some bias. Youku was the most popular website and had the largest audience in China. Youku in mainland China may still reflect the reliability of information available on video websites. Third, our results comprise a snapshot of information distribution to illustrate the quality of internet video at one point in time in China mainland, and these results may change according to the videos that can be added or removed with time.