Public health ethics (PHE) is a field that is still developing within the broader field of bioethics. The topic concerns the complex moral and ethical implications of numerous strategies and acts intending to preserve, enhance, and sustain public health (PH). PHE uniquely integrates ethical issues and empirical elements within health policy and science. In an atmosphere characterized by increasing risk factors, such as the emergence of infectious diseases like the coronavirus disease 2019 (COVID-19) pandemic and the persistent challenges presented by chronic health conditions like obesity and smoking, there is a greater focus on the complex ethical dilemmas inherent in PH. The field of study garners the interest of policymakers, PH professionals, and community stakeholders due to its complicated ethical issues related to PH approaches and interventions.12

The primary goal of PH practices is to prioritize preventive medicine, emphasizing disease prevention over treatment. Unlike medical specializations that focus on individual patients, PH policies attempt to improve the health of entire populations. Due to differences in clinical and PH approaches, the ethical standards used in PH can vary considerably. Due to the preventive nature of PH, the discipline confronts challenges regarding the extent of action that should be pursued and the moral and ethical implications associated with potential infringement upon individual liberties.34

In the era referred to as the Information Age, characterized by notable technological breakthroughs, a significant portion of the population has interacted with the Internet due to the widespread use of smartphones. The Internet has emerged as a significant facilitator, accelerating the accessibility of diverse information across multiple fields.56 Social media platforms have undergone significant progress and now serve as valuable tools for facilitating the rapid dissemination of scientific content immediately upon its release.78 YouTube, a well-recognized platform for sharing videos, has increasingly become a popular tool for disseminating health-related information. Historically, individuals frequently relied on written sources to access information. However, the extensive utilization of the Internet has resulted in a significant shift towards disseminating such information through video-sharing platforms.910 Free usages and a user-friendly interface are other advantages. Social media can also spread incorrect or misleading data.11 This condition stems from the lack of a regulatory structure on the platform responsible for monitoring and reviewing the norms and quality of content.12

The primary goal of this research is to evaluate the PHE videos on YouTube. The study aims to determine the degree of misinformation in a body of PHE videos on YouTube. It also seeks to identify reliable sources of high-quality videos. Such an endeavor is advantageous for directing consumers to trustworthy sources of information. Furthermore, evaluating the videos will help develop future ways for generating educational videos that efficiently serve the public and healthcare professionals' interests.

This descriptive study delved into YouTube (https://www.youtube.com/) as its primary research arena, with video scans executed on October 25, 2023. When establishing the appropriate search terms, the authors have reached a consensus, with due consideration given to MeSH terms. Search terms are ‘public health,’ ‘healthcare,’ ‘health services administration,’ and ‘health policy and ethics.’ The researchers performed steps to avoid potential biases to ensure the search was conducted independently of previous searches. The researchers diligently wiped the digital slate clean, erasing the Internet browser’s cookies and search history to ensure an unbiased search, conducting it in incognito mode. This strategy was used to keep the search’s integrity and neutrality, preventing personalized search results or past data from influencing the study’s findings.1213 The researchers decided to utilize the “relevance” filter by default on YouTube to ensure the accuracy and pertinence of the search outcomes. Through this procedure, they attempted to align their search lists with the typical experiences of the general population when using the platform to conduct inquiries. According to existing research, most individuals restrict their inspection of search results to the first three pages. Historically, YouTube employed a design wherein 20 videos were presented on each page. However, the platform has since transitioned to a continuous style for displaying search results. Given this context, the research employed a methodology in which the initial 60 videos corresponding to each search term were subjected to analysis.1415

The review process comprised two authors, AA and BFK, doing independent assessments of the videos. In cases where there were inconsistencies, consensus was reached to address them. The evaluation process excluded videos that were repeated, irrelevant, unrelated to PHE, in a language other than English, or of low audio/visual quality. Out of the total number of videos, 27 were identified as duplicates, 70 were deemed irrelevant to the issue, and three were found to be in a non-English language. Moreover, three were determined to have poor audio/visual quality. Consequently, 137 videos meeting the stringent evaluation criteria were enlisted for in-depth analysis. Cohen’s kappa coefficient was employed to gauge the concordance in their evaluations.

At the outset, a cumulative count of 240 videos was recorded. After applying the exclusion criteria, ratings were conducted on 137 videos (Fig. 1). The videos were categorized based on their sources, which included university-hospital (n = 13; 9.5%), government (n = 10; 7.3%), physician (n = 19; 13.9%), non-profit organization (n = 18; 13.1%), website (n = 14; 10.2%), academic institution (n = 6; 4.4%), Internet user (n = 36; 26.3%), non-physician health professional (n = 9; 6.5%), and news (n = 12; 8.8%). Table 1 displays the overarching attributes of the videos.

The quality groups based on the GQS framework were established. Out of the entire dataset of 137 videos, 65 (47.5%) were categorized as high quality, 51 (37.2%) as moderate quality, and 21 (15.3%) as low quality. Analyzes were performed independently in the high and low-quality groups. Ultimately, the goal was to discover, in percentage terms, which sources contributed most to high and low quality. Academic (n = 5; 83.3%), government (n = 7; 70%), physician (n = 13, 68.4%), and university-hospital (n = 8; 61.5%) are the sources with the highest percentage of high-quality videos. On the opposite end of the quality range, Internet user (n = 12; 33.3%) and news (n = 3; 25%) provided low-quality videos (Table 2).

Comparisons were conducted on the video parameters between the quality groups, with the per-day values serving as the foundation for obtaining more precise outcomes. Significant differences were seen across the groups in DISCERN score, per day views, likes, and comments (P = 0.001 for views per day and P < 0.001 for other parameters). The high-quality group exhibited the highest median DISCERN score. The low-quality group displayed the highest median values of daily views, likes, and comments (Table 3).

The Kappa coefficient was computed to be 0.81.

This study conducted a thorough investigation of YouTube as a critical platform for the dissemination of information on PHE. The ever-changing characteristics of PHE and the growing incidence of health-related issues have brought ethical questions in PH measures to the forefront. In the Information Age, characterized by significant technological improvements that have become the Internet an omnipresent repository of information, it is crucial to comprehend the standards of reliability and quality of content disseminated on platforms like YouTube.21 The present article’s key findings are as follows:

Despite the positive outcome of almost half of the videos being categorized as high-quality and the comparatively low percentage of low-quality videos, it is imperative not to overlook the issue. Videos of low quality are recognized as a prominent tool for disseminating misleading, incorrect, and biased information.22 The emergence of low-quality videos poses a significant risk to the PH.

Classifying video sources is crucial in defining the domain of PHE information. University-hospital, academic, government, and physician sources emerged as the primary providers of high-quality videos. Contrastingly, Internet users and news sources were associated with low-quality videos. The analysis of PH information regarding COVID-19 vaccination on YouTube revealed that medical professionals obtained the highest DISCERN scores, while Internet users obtained the lowest outcomes.23 A YouTube article on COVID-19 highlighted professionals and government entities as sources of factual information while emphasizing the prevalence of non-factual information from news outlets and Internet consumers.24 An article on YouTube on ankylosing spondylitis exercises mentioned academic, university, and physician as high-quality video sources, consistent with our findings.25 The results emphasize the importance of reliable and knowledgeable professionals in PH education. Academic institutions and government organizations, renowned for their policy and research functions, exert significant influence over the dialogue surrounding PHE. Physicians’ significant influence in providing high-quality content underscores the responsibility of healthcare practitioners to distribute precise and morally sound health information. The decentralized structure of independent user-generated online content, which frequently lacks professional supervision, makes ensuring accuracy and reliability challenging. While news outlets are influential, they may favor sensationalism over sophisticated ethical debates.

The differences in DISCERN scores, daily views, likes, and comments among the quality groups provide intricate and nuanced perspectives. Firstly, it can argued that there is a parallel progression between the quality as measured by the GQS and the reliability as measured by the DISCERN score. High-quality videos can be regarded as reliable sources. Second, low-quality videos received more daily views, likes, and comments. The existing literature presents conflicting findings about this particular topic. An analysis of orthodontics videos on YouTube found that videos with excellent information content had a considerably greater interaction index.26 Examining fibromyalgia videos revealed no statistically significant link between DISCERN scores and the like ratio and video power index.27 In support of our results, an examination of videos related to rotator cuff repair revealed that sources of poorer quality tended to get greater attention.28 There may be several factors that contribute to the inconsistent results. Possible factors might include changes in the subject matter being examined, the timing of the assessments being carried out, and discrepancies in the inclinations of Internet users. However, discovering this paradoxical phenomenon encourages contemplation regarding the intricacies of online interaction. The presence of high-quality content has the potential to attract an audience that values in-depth analysis and factual accuracy. Conversely, low-quality information may generate greater interaction due to its sensationalized or misleading characteristics.

The study possesses several limitations. Neglecting videos in languages other than English may give rise to linguistic bias, perhaps resulting in disregarding important information available in other languages. Therefore, the potential constraint on the generalizability of our findings to other languages and nations may exist. The quality of videos was assessed using a single time point. However, it should be noted that search results may exhibit variability over time. We restricted the number of videos analyzed for each search phrase. More video examinations would have resulted in more comprehensive results. The video contents were not categorized, and sub-breakdowns were not created.

Our results suggest that PHE-related YouTube videos encompass a wide range of high-quality and low-quality content. Furthermore, the current study emphasizes the importance of source evaluation in attaining high-quality videos. The essential role of quality control techniques on social media platforms in ensuring accurate and ethical health information transmission emerges. Authors should take caution, prioritizing appropriate referencing and rigorously investigating content for potential promotional, deceptive, or poor-quality information on YouTube and comparable platforms in the shifting digital ecosystem.29