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 Table of Contents  
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 67-73

YouTube™ as a provenance of guidance on oral cancer among dental professionals and patients in India: An analytic observation

1 Department of Oral Medicine and Radiology, Rama Dental College, Kanpur, Uttar Pradesh, India
2 Department of Public Health, UWA School of Population and Global Health Australia, Nedlands, Australia

Date of Submission29-Aug-2021
Date of Acceptance30-Sep-2021
Date of Web Publication23-Dec-2021

Correspondence Address:
Kriti Garg
117/K-68, Sarvodaya Nagar, Kanpur, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijohr.ijohr_22_21

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Context: We examined the content of YouTube™ videos on oral cancer and evaluated their usefulness in promoting the early detection of oral cancer. Aims: This study aimed to analyze the videos available on YouTube™ related to dentistry and the oral cancer. Settings and Design: An analytic observation was performed. Subjects and Methods: The top 245 English-language videos on oral cancer with at least 300 views were analyzed. Demographics of videos, including target audience, source, country of origin, content, number of views, time watched, average views, duration, like/dislike ratio, and two researchers independently assessed the videos for usefulness in promoting the early detection of oral cancer. Statistical Analysis Used: Total video information and quality index (VIQI) scores were calculated, consisting information, accuracy, quality, and precision indices. Nonparametric tests were used for the analysis. Results: A total of 245 YouTube™ videos (147) patient-oriented educational videos and 98 testimonial videos) were analyzed. There was no significant association between video usefulness and viewing rate, viewers' involvement, or video duration, and the most valuable videos were ranked last on the viewing list. When compared to videos produced by professional organizations or health-care professionals, videos uploaded by individual users were less useful. A comparison of the indices according to the relevance of the videos showed statistically significant differences in the videos' information and precision indices and total VIQI scores. Conclusions: By uploading beneficial videos and referring patients to credible information sources, health-care professionals, academic institutions, and professional organizations can improve the content of YouTube™ regarding oral cancer.

Keywords: Cancer, dental, internet, mouth, patient, video

How to cite this article:
Garg K, Sachdev R, Shwetam S, Srivastava AR. YouTube™ as a provenance of guidance on oral cancer among dental professionals and patients in India: An analytic observation. Indian J Oral Health Res 2021;7:67-73

How to cite this URL:
Garg K, Sachdev R, Shwetam S, Srivastava AR. YouTube™ as a provenance of guidance on oral cancer among dental professionals and patients in India: An analytic observation. Indian J Oral Health Res [serial online] 2021 [cited 2024 Mar 2];7:67-73. Available from: https://www.ijohr.org/text.asp?2021/7/2/67/333378

  Introduction Top

Oral cavity and oropharyngeal cancers are the sixth most prevalent cancer in men and women worldwide, contributing to almost 3:2 of all malignancies.[1] In emerging nations such As India, it is the most widespread cause of cancer, accounting for up to 40% of all cancers.[2],[3] The annual estimated incidence is around 275,000 for oral and 130,000 for pharyngeal cancers cases occurring in developing countries.[4] The preponderance of these cancers is caused by preventable risk factors such as tobacco smoking and chewing, alcohol dependence, and areca nut consumption.[5],[6],[7]

Oral cancer has a suboptimal prognosis, with a 5-year survival rate of about 50%; this is primarily due to delays in detection and treatment.[8],[9] Despite actuality, even in developed nations, most oral cancers are diagnosed late, resulting in more complicated treatment and a shorter life expectancy.[10],[11] The lack of public awareness of oral cancer and inadequate early diagnosis by dental health-care professionals have been criticized for the late diagnosis of mouth cancer.[12],[13]

Customarily, it has been the role of dental health providers and dental institutions to educate patients with oral health-care education. Furthermore, due to the internet's increased popularity and accessibility, patients' expect to be properly informed, and the reduced cost compared to professional health-care consultation, the public's usage of the Internet to acquire medical and dental information has expanded in the recent decade.[14] Patients utilize the internet to discover not just medical and dental knowledge but also diagnoses and remedies for their diseases.[15] Following Google™ (trademark) and Facebook™, YouTube™ is a video-sharing Web site that was established in 2005 to allow free video streaming. On YouTube™, 100 million videos are seen every day, and the site adds over 65,000 new videos every day.[16] Numerous health-care specialties have explored the use of YouTube™ videos for patient education and health improvement.[17],[18],[19],[20] According to a study published, YouTube™ is more effective than other popular social media Web sites including Facebook, Twitter™, in influencing patients' perspectives toward cancer risk reduction.[21] Moreover, since YouTube™ videos are not committed to peer review, there are questions about their authenticity, trustworthiness, and scientific credibility.[22] Assessments of You-Tube™ content on medical topics such as prostate cancer, immunization, Ebola virus infection, hypertension, and coronavirus disease-2019 have revealed a significant spectrum of quality in the knowledge provided.[19],[20],[22] To our information, no research on the content of YouTube™ videos on oral cancer has been performed in India. This study aimed to analyze the videos available on YouTube™ related to dentistry and the oral cancer and we examined the content of YouTube™ videos on oral cancer and evaluated their usefulness in promoting the early detection of oral cancer.

  Subjects and Methods Top

The institutional ethics committee of the private dental college and hospital in Kanpur (Uttar Pradesh, India) approved this study with the ethical approval number RDC/RC/25. Based on the Cohen's effect size (0.4035 effect size), 92% power, and 0.05 error margin, 245 was calculated as the total sample size, using the following formula:[23]

YouTube™ video search

We applied the default configuration to search YouTube™ (www.youtube.com) for videos about oral cancer on the 5th and 6th of June 2021; a new account was formed for this study, and the terms “dental,” “mouth cancer,” and “oral cancer” were explored. However according to previous research, 95% of users who execute an online search on YouTube™ would only watch the first 60 videos of the results, yet most studies utilizing YouTube™ as a web browser have used 60–200 videos.[24]

Selection of videos

This research only included English language videos with at least 300 views that were uploaded after January 2021; videos in other languages were eliminated. Videos about oral cancer in animals, videos with no sound or headings, duplicate videos, unimportant videos such as comics and songs, videos about certain types of cancer, videos demonstrating a surgical procedure used for oral cancer treatment, antismoking advertisements, videos describing the findings of a research paper/project, and videos primarily about oral cancer were all excluded from the initial screening.[23] The Uniform Resource Locator of the first 245 results matching the study criteria in decreasing order of “relevance” were saved electronically due to daily changes. If a video had subtitles, they were used to help with comprehension. All videos were reviewed and analyzed by two researchers (K. G and S. S) independently assessed videos. K. G is an oral medicine specialist with 10 years of clinical experience, and S. S is oral medicine post graduates who completed an oral cancer continuing education course tailored for the purpose of this study and for interobserver reliability.

Analysis of videos

The following data were saved for each video: target audience (dental professional and patients); source university and professional organizations-WHO, news agency and others etc.]; country of origin (United States of America, India, United Kingdom, Canada, and other); main content (general information about oral cancer). We gathered data on each video's title, upload date, country of origin, time watched (elapsed day after video upload); average everyday views and duration (in minutes); like/dislike ratio; and usefulness.

A “usefulness score” was developed to classify each video to assess the utility of the content videos. The videos were assessed for content in the five nonexclusive domains of oral cancer knowledge, including etiology/risk factors, prevention/early detection, management, and prognosis/outcome. A “usefulness score” ranged from 0 to 10 was devised to categorize videos as not useful, slightly useful, moderately useful, and very useful [Table 1]. The scores ranged from 0 to 10: A score of 10 indicated that the video mentioned the main oral cancer risk factors (smoking, alcohol, chewing habits, and excessive sun exposure), described the main early presentations of oral cancer (white/red lesion, ulcer, and lump), used representative clinical images to describe oral cancer appearance, and conveyed a positive message about oral cancer screening and avoidance of risk factors. Score 0 indicated that the video contained no information about risk factors and clinical signs of oral cancer and did not convey a positive message about early detection and avoidance of risk factors. Videos containing information that was not scientifically proven, or videos promoting the use of tobacco products, alcohol, or other risk factors, were categorized as misleading.[14]
Table 1: Video usefulness score scale

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The video information and quality index (VIQI) was used to determine video quality.[19],[25] The VIQI, consisting of the contents in the Global Quality Scale, is used to evaluate the overall quality of the videos. The contents of the index included information accuracy, quality (images, animations, interviews, subtitles), and precision (title–content compatibility) indices. Each component of the VIQI score was evaluated using a 5-point Likert scale ranging from 1 (poor quality) to 5 (high quality). The equivalents of the scores were made according to the following criteria: Score 1: poor quality, most information missing, not useful; Score 2: generally poor quality, very limited information; Score 3: moderate quality, some important information is available but others are not, somewhat useful, Score 4: good quality, most of the relevant information is available, but there are deficiencies in the topics, useful, Score 5: excellent quality, very useful.[26]

Statistical analysis

Statistical analysis was performed using MedCalc Software Ltd version 20.006 (MedCalc Software Ltd 64-bits, Acacialaan 22, 8400 Ostend, Belgium). Descriptive statistics (mean, standard deviation, median, frequency, rate, minimum, and maximum) were performed, and the distribution of the data were calculated using the Shapiro–Wilk test. For intra-observer reliability, the Wilcoxon test was used to compare periodic quantitative data (VIQI scores), and the McNemar test was used for qualitative data (usefulness). For inter-observer reliability, the Mann–Whitney U-test was used to compare quantitative data, and the Chi-squared test was used to compare qualitative data. For the correlation of data, Spearman's test was performed. The level of statistical significance was P < 0.05.

  Results Top

Output and distribution of YouTube™ search on oral cancer

A total of 312 videos were obtained by using keywords “ental,” “mouth cancer,” and “oral cancer.” Videos in channels and playlists are accessible as individual videos by default, and consumers typically search YouTube™ for videos rather than specific channels or playlists. Therefore, we analyzed the first 312 individual videos of the output for each search term. The 245 videos that have been initially reviewed were categorized into one of two types based on their principal theme: educational (videos that aimed to raise awareness about oral cancer or contained information about oral examination, diagnosis, signs and symptoms, risk factors, and management of mouth cancer) (n = 147) and as testimonial (videos reporting a personal experience with oral cancer) (n = 98). The total duration of all analyzed videos was approximately 22 h. These 245 videos attracted approximately a total of 387,000 views.

Characteristics of YouTube™ videos on oral cancer

In the current study the target audience was categorized as patients 53.46% and dental professionals as a total of 46.53%. More than half of the videos (32.24%, n = 75) were uploaded by healthcare professionals, 26.5% by TV channels or news agencies, 27.3% by universities or professional organizations, and 13.8% by individual users as well as health information Web sites. Majority of the videos (40%, n = 98) were uploaded by users in USA, 25.7% (n = 63) by users in India, 15.1% (n = 37) by users in the United Kingdom (England), 11.02% (n = 27) by users of Canada, and 8.16% (n = 20) in other countries (Pakistan, and Philippines). Of the five content domains assessed, etiology/risk factors domain (31.8%, n = 78) followed by management domain (31.02%, n = 76), prevention/early detection domain (17.5%, n = 43), and information about oral cancer (15.9%, n = 39) and only 3.67% for the prognosis of oral cancer [Table 2].
Table 2: Distribution of the target, source, country of origin, content, and usefulness of 245 most popular English language oral cancer-related videos

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The usefulness of videos in conveying the key risk factors and indications of oral cancer, as well as promoting early diagnosis and avoidance of risk factors, was evaluated using a 10-point usefulness score. Videos advertising smoking, alcohol, or other risk factors or providing scientifically unsubstantiated information were deemed misleading. The overall usefulness score of included videos ranged from 0 to 10. There were 33 (13.4%) misleading videos, 84 (34.2%) not useful videos, 84 96 (39.1%) moderately useful videos, and 32 (13%) very useful videos [Table 2].

Comparison of the indices

The duration of the videos ranged from 1 min to 95 min and the total VIQI scores ranged from 1 to 20. Video quality indices and total VIQI scores averages were moderate. The descriptive analysis of the characteristics and quality of the videos is summarized in [Table 3]. [Table 4] compares indices by the intended audience, source, and country of origin, as well as content, usefulness, and relevance. In terms of target audience, it was found statistically significant that the information (P = 0.001), and quality (P = 0.037) indices and total VIQI scores (P = 0.001) of videos intending dental professionals were higher than these for patients. When videos were compared by source, there were statistically significant differences in the information (P = 0.001) indices and total VIQI scores (P = 0.067). It was revealed that the information (P = 0.014), and precision (P = 0.001) indices and total VIQI scores (P = 0.011) of high relevance (HR) videos were statistically higher than low relevance (LR).
Table 3: Descriptive analysis of the characteristics and quality of 245 most popular English-language oral cancer-related videos

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Table 4: Comparison of indices according to target, source, country of origin, content, usefulness, and relevance of the videos

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Types and topic domains

Our search of YouTube™ videos revealed a total of 147 patient-oriented educational videos and 98 testimonial videos. The mean length of testimonial videos (4.54 min ± 3.68) was comparable to that of educational videos (6.02 min ± 4.37) (P = 0.01), and there were no significant differences in terms of interaction index scores between the two types of videos. Testimonial videos were viewed more frequently than educational videos, and an average testimonial video was viewed 40.9 times every day compared with 14.8 views every day for an average educational video (P = 0.001) [Table 5].
Table 5: Comparison between educational and testimonial YouTube™ videos on oral cancer

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Correlation analysis

The correlation analysis of the data is presented in [Table 6]. For the indices and total VIQI score, the correlations varied positively between weakly to extreme relationships (P = 0.001).
Table 6: Correlation analysis of the oral cancer video data

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Reliability analysis

Regarding the usefulness of the videos and total VIQI scores; no statistically significant difference was detected for either intraobserver (P = 0.067 and P = 0.845) or interobserver reliability (P = 0.772 and P = 0.092), respectively.

  Discussion Top

Previous research has investigated YouTube™ as a source of information on subjects such as the Ebola virus, chronic obstructive pulmonary disease, immunization, hypertension, and prostate cancer.[17],[18],[19] Oral cancer has a good prognosis if diagnosed early, but most instances are discovered later due to patients' lack of awareness of the symptoms and risk factors.[10],[23]

As per our observations, YouTube™ provides a wide spectrum of oral cancer information, ranging from highly specialized medical knowledge to general health education and personal experience with the disease. Remarkably, videos documenting a person's experience with oral cancer were viewed more frequently than educational videos, despite being less useful – possibly because viewers find these types of videos more entertaining and hence more likely to watch them. The majority of YouTube™ videos on oral cancer emphasized the significance of early detection through self or professional oral screening, as well as positive notifications about risk factor prevention. The majority of these videos, however, failed to sufficiently depict the early signs suggestive of oral cancer, a fact that may restrict the utility of YouTube™ videos in promoting the early detection of oral cancer.[21] Oral cancer risk factors were frequently discussed in YouTube™ videos. In contrast to cigarette smoking, most patients do not perceive alcohol consumption as a risk factor for oral cancer, according to previous research.[27]

YouTube™, like several other popular social media Web sites, allows any registered user to upload health-related videos that have not been peer-reviewed and the source of information contained in these videos is unknown. As a result, YouTube™ is vulnerable to the broadcast of dubious and potentially dangerous videos that aren't always backed up by real scientific evidence. Despite this, we only identified a few misleading YouTube™ videos on oral cancer, some of which were potentially harmful since they encouraged snuff dipping or promoted unsubstantiated “therapies.”[21] Even though the number of misleading videos was modest, they were typically viewed by a high number of people.[17],[28] As a consequence, patients may have difficulties discerning whether videos are trustworthy and thus worth watching. In previous research examining YouTube™ material on health-related issues, the outcomes of users' interaction with videos were inconsistent.[21],[29] There was no significant correlation between the usefulness of the video and the watching rate or the interaction index score. Even though YouTube™ ranks its videos based on viewership and interaction scores, this adds another constraint to using YouTube™ as a source of information about oral cancer.[4]

The present study used a small-scale selection method, and videos were objectively evaluated for their efficacy in encouraging early identification of oral cancer using a novel scoring system that demonstrated satisfactory interobserver agreement. The current study, on the other hand, has a few shortcomings. We conducted two separate searches using the keywords “mouth cancer” and “oral cancer,” which are the most common keywords a layperson would use while searching YouTube™ for information on this matter. Some patients, on the other side, may use alternative search phrases and get different results. YouTube™ content is highly dynamic, with videos being uploaded and removed regularly. As a result, the search results may vary depending on the day and time of the search. Our study, along with many others, suffered from a “snapshot” approach to data acquisition. Future research should take a longitudinal or field-based strategy to evaluate the usefulness of YouTube™ as a source of patient education regarding oral cancer. Even though two-thirds of oral cancer instances occur in developing countries where English is not necessarily the primary language, we only evaluated videos in English. Because the United States and the United Kingdom have the highest Internet penetration rates, it is no coincidence that the preponderance of videos on YouTube™ is in English.[21] Studies from other countries will be useful in determining how cultural variables influence the content of YouTube™ and how patients from various cultures utilize YouTube™ for health education.

  Conclusions Top

YouTube™ contains diverse information on oral cancer. The importance of prevention through the early detection and avoidance of risk factors is widely discussed in YouTube™ videos. The majority of videos emphasize cigarette smoking as a risk factor for oral cancer; however, there are fewer videos that discuss other risk factors such as tobacco chewing, alcohol consumption. Mostly, all YouTube™ videos concerning oral cancer do not appropriately acknowledge the source of the information they include, and only a few videos include representative clinical photos of oral cancer and possibly malignant conditions. By uploading beneficial videos and directing patients to trustworthy information sources, dental health-care professionals, academic institutions, and professional organizations can contribute upgrade the quality of YouTube™ concerning oral cancer.


The authors would like to thank institutional Internet technical section for their constant help and support throughout the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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