Content and Quality of Online Videos About Ostomy Pouch Changes: A Descriptive Study

A colostomy is a surgical procedure in which the normal intestinal passage is interrupted with an artificial opening in the colon.^1,2 Major health problems that lead to the need for a temporary or permanent colostomy include colon or rectal cancer, chronic inflammatory bowel diseases, diverticular disease, irradiation damage, and trauma.^1-3 A colostomy and its care greatly affect the daily life of the patient. The colostomy pouch system consists of a flexible adhesive and solid skin barrier that is placed at the stoma and an odor-proof pouch to collect stool.^4-6

The individual with ostomy must acquire new skills while adapting to body image changes and new conditions.⁴ Hence, the patient needs comprehensive and individualized special care and training.^2,5,7 The insufficient number of medical specialists in ostomy care is an important factor that reduces the quality of care.⁸ In 2018, a prospective study⁹ was conducted in Australia to determine the time taken for patients to achieve the ability to perform self-care for their new stoma. In the study, 29% of 107 patients with ileostomy and colostomy were unable to perform self-care at discharge.⁹ In 2018, a cross-sectional study¹⁰ was conducted to identify ostomy self-care challenges among 177 patients who had a stoma for more than 5 years and were registered in northern California and the Northwest (Oregon and southwest Washington state).¹⁰ In this study, 63% of the individuals who survived long-term rectal cancer had at least 1 ostomy self-care problem, and 31% of the patients had 2 or more.¹⁰ Additionally, lack of ostomy care support or insufficient education may prevent individuals from developing the ability to manage their stoma, which may lead to depression and/or social isolation and increased health care needs and expenses.^9,11

Patients and/or their caregivers may use the internet for learning and developing skills related to their condition.^12,13 YouTube is a leading and extensively used website for distributing health-related information and is well-known for hosting self-help videos. It was founded in 2005 as a video-sharing platform,¹⁴ and it is a highly visited website that contains many videos related to patient education. Thus, it has great potential to provide easy access to health information; however, the accuracy and usefulness of the information are undetermined.^13,15,16

While some studies reported that YouTube videos were a crucial source of information for patients, others reported that these videos were insufficient.^13,15,17 These studies were related to rheumatoid arthritis,¹⁷ methotrexate injection,¹² subcutaneous antitumor necrosis factor (TNF) agent injection,¹⁵ glioblastoma therapy,¹⁸ breast self-examination,¹⁶ oral leukoplakia,¹⁴ clean intermittent catheterization,¹³ and pelvic floor muscle exercise.¹⁹ We found 2 studies that examined YouTube videos on ostomy-related patient education. These videos discussed colostomy and ileostomy care.^20,21 Basim and Argun²⁰ analyzed 84 videos on patient education related to ostomy on June 20, 2020. They found that 58.33% of these videos were useful.²⁰ Azer et al²¹ analyzed videos published before May 18, 2019, on colostomy and ileostomy. They found that 35% of the 149 videos included in the study were educationally useful.²¹

The current study included only videos on colostomy care. This was done because there might be differences between the information provided for colostomy and ileostomy care. The authors analyzed and determined the content and quality of YouTube videos on colostomy pouch change regarding their usefulness in providing educational information.

Research design and setting. A descriptive study was performed to analyze the content and quality of YouTube videos on colostomy pouch change. All videos posted to YouTube (youtube.com) until March 15, 2021, that resulted from searching using the key words “colostomy care,” “colostomy bag/pouch change,” and “ostomy bag/pouch change” in English were viewed (N = 128).

Inclusion criteria. The analysis included audio and English-language videos on changing a double-piece colostomy pouch for adults. A total of 94 videos met the inclusion criteria and were analyzed.

Exclusion criteria. A total of 34 videos were excluded for the following reasons: non-English videos (n = 4), showing only new pouch insertion (n = 4), no audio (n = 3), 1-piece pouch change (n = 16), and pouch change among pediatric patients (n = 7) (Figure).

Data collection tools. The YouTube Videos Characteristics Form was used for each video, which included information about the time elapsed since the video was uploaded; the length of the video; the total number of views; the number of likes, dislikes, and comments; and the source (ie, institutions, professionals, websites, patients) of the video.

Content. The content of the videos was evaluated with a 10-item Colostomy Pouch Change Skill Form prepared by the researchers, following the recommendations of the Wound, Ostomy, and Continence Nurses Society⁴ and the United Ostomy Associations of America New Ostomy Patient Guide.²² A score was given for each step described in the video. The scores in the Colostomy Pouch Change Skill Form ranged from 0 to 10. Higher scores indicated better video content. The created skill form was submitted for evaluation to 8 instructors, who were experts in the field, and was then finalized. The expert opinions’ Content Validity Index score was 0.921.

Quality. The quality of the videos was assessed with a 5-point Global Quality Score (GQS) developed by Bernard et al.²³ The form consists of 5 scores: 1 indicates poor quality, 2 indicates low quality and limited use, 3 indicates somewhat useful quality, 4 indicates useful quality, and 5 indicates useful and excellent quality. During the evaluation, the element that best expressed the quality of the video was selected.²³

Data collection. The content and quality of the videos included in the study were evaluated by an enterostomy nurse with 10 years of experience in the stoma therapy unit and a physician with experience in colostomy surgery. The analyzed videos were classified as “useful” or “useless” according to information transfer. The content score and quality score were used to determine whether the videos were “useful.” Videos with average and above-average scores were included in the “useful” video category, while those with below-average scores were included in the “useless” video category.

Ethical considerations. The study was approved by the Ethics Committee of Artvin Çoruh University (decision number 2020/87). The information of the institutions and individuals who uploaded the videos was kept confidential.

Statistical analysis. Data were analyzed using the Statistical Package for Social Sciences, Version 22.0. Categorical variables were presented as numbers and percentages. The compatibility between the independent observers was determined using the Kappa value. The distribution of the variables was measured by the Kolmogorov-Smirnov test. The differences between and among groups were evaluated by performing analysis of variance and were considered statistically significant at P < .05.

The content of the 94 videos included in the study was examined by 2 independent health care professionals. The Kappa value between the observers was 0.97. The total period of availability of the videos on YouTube was 49.35 ± 29.54 months, the length of videos was 9.63 ± 5.68 minutes, the number of views was 241,264.79 ± 724,349.051, the number of likes was 1476.69 ± 4088.378, the number of dislikes was 153.61 ± 419.591, and the number of comments was 180.64 ± 626.984. When the videos were analyzed for content and quality, the mean score of content was 8.24 ± 1.56, and the average GQS was 3.14 ± 0.97. It was found that 42.6% of the videos were medium quality. Additionally, 46.8% of the videos were uploaded by patients (Table 1).

The correct colostomy pouch change steps were evaluated (Table 2). The results showed that the highest correct application step (100%) was, “The skin barrier is fully adhered to the skin. Since the heat of your hand will make the skin barrier stick better, run your finger over the skin barrier for 30 seconds. When the skin barrier reaches body temperature, it will soften and become more easily malleable.” The lowest correct application step (33%) was, “Check that the pouch is firmly seated in the skin barrier by pulling gently on yourself.”

When the characteristics of the videos were examined, 66 (70.21%) videos were evaluated as useful, and 28 (29.79%) videos were useless (Table 3). The average period of availability of useful videos on YouTube was 54.51 ± 30.87 months, the length of the videos was 10.38 ± 5.80 minutes, the number of views was 306,330.42 ± 8512.372, the number of likes was 1799.26 ± 481.027, the number of dislikes was 192.55 ± 493.576, and the number of comments was 22.78 ± 7.421. The total period of availability on YouTube, the length of the video, total views, and the number of dislikes differed significantly between useful and useless videos (P < .05) (Table 3). Regarding the content and quality of the videos, the mean score of useful videos was 9.09 ± 0.83, and the average GQS was 3.53 ± 0.76, which was significantly higher than those of useless videos (6.17 ± 0.90 and 2.25 ± 0.75, respectively; P < .05). The results indicated that 57.6% of the videos containing useful information were uploaded by universities, associations, health care professionals, or medical companies, and 63.3% of the videos containing misleading information were uploaded by patients; the difference was statistically significant (P < .001).

When the characteristics of the sources that uploaded the videos were examined, it was found that the videos uploaded by universities, professional organizations, and health care professionals had the highest mean scores of content and GQS (9.25 ± 0.91 and 3.87 ± 0.70, respectively) and the difference was statistically significant (P < .05). The total period of availability on YouTube (59.96 ± 27.13 months) was the highest for the videos uploaded by universities, professional organizations, and health care professionals, and the difference was statistically significant (P < .05; Table 4).

YouTube is an easily accessible and easy-to-use video-sharing platform with billions of page views per day since its establishment in 2005.¹⁷ YouTube comprises 95% of all internet users and has great potential to provide easy access to health information.^13,15,16 However, given the limited assessment of the quality of the information by consumers, there is a risk of useless information being spread.^12,17 Studies from around the world have reported very few videos on colostomy care.

Currently, with technological advancements, the internet has become an important and popular source of health information.^13,15 The National Health Interview Study reported that 43.55% of adults in the United States used the internet to search for health information in 2011.¹⁵ According to the findings of the current study, many people watched YouTube videos to learn more about colostomy pouch change or for other reasons, and individuals sought help to learn about and develop skills for changing colostomy pouches.

Unreliable information, especially in training videos for skill-building, may mislead patients and cause undesirable results because of incorrect or incomplete application.^13,24 Thus, it is important to analyze the quality and accuracy of videos on YouTube. To the best of the authors’ knowledge, there have been 2 studies published on this subject.^21,22 One of the studies analyzed the content, reliability, and quality of 84 videos on ileostomy and colostomy. The results showed that 58.33% of these videos were useful. The content and quality scores of useful videos were significantly higher than those of useless videos.²¹ In the other study on ileostomy and colostomy, 149 videos were analyzed. Most of these videos were not useful and were unsuitable for guiding patients.²² The results of the current study might differ from those of the previous studies because the samples were not similar and the time of analysis of the videos was different.

When studies on different subjects were examined, 54.9% of the videos on rheumatoid arthritis, 51.4% of the videos on Sjögren syndrome, 50% of the videos on subcutaneous anti-TNF agent injection, and 64% of the videos on clean intermittent catheterization were found to be useful.^13,15,17,25 In contrast, Esen et al¹⁶ found that 37.9% of the videos on breast self-examination were useful and 62% were useless. The results of this study showed that useful videos had higher content and quality scores.Of the 94 videos examined in the current study, 66 (70.21%) were useful and 28 (29.79%) were useless; the content and quality scores of useful videos were found to be significantly higher.

When the characteristics of useful and useless videos were examined, the length and duration of the videos on YouTube were found to be higher for useful videos, and the number of dislikes was higher for useless videos. The content and quality scores of useful videos were also higher. These results were similar to those of a study by Basim and Argun.²¹ The results were also partly similar to those of a study by Azer et al.²² Moreover, the current results were similar to those of the studies that examined training videos on rheumatoid arthritis,¹⁷ subcutaneous anti-TNF agent injections,¹⁵ and clean interval catheterization applications posted on YouTube.¹³

Most of the useful videos were uploaded by universities, professional organizations, and health care professionals, and 67.9% of the useless videos were uploaded by patients. The study by Basim and Argun,²¹ in which ostomy-related patient education videos were analyzed, found that most of the useful videos were uploaded to YouTube by health care professionals. This finding, which was in line with the results of other studies that analyzed training videos on rheumatoid arthritis,¹⁷ breast self-examination,¹⁶ and subcutaneous anti-TNF agent injection,¹⁵ emphasized the importance of professional authorities taking up more roles and responsibilities to increase the number of accurate, high-quality, and useful videos on colostomy pouch change.

This study had several limitations. To evaluate the content of the videos, the authors created a checklist following established guidelines. Applications only for the same ostomy type were evaluated for convenience and ease of analysis. Additionally, the scale used to evaluate the quality of the videos was based on the information present in the videos. Therefore, different types of ostomy were not included. The results and inferences of this study were restricted to colostomy videos only.

The YouTube videos on colostomy pouch change examined in this study were limited to those videos that were available and accessible only in English as of March 2021. YouTube is a dynamic video platform that constantly changes according to the popularity and time when the video is uploaded. Search results may vary over time. Also, the algorithm of YouTube search can affect search results based on geographic location. Similarly, because users can filter the results, a different filter might yield significantly different results.

The videos were classified as useful or useless according to the criteria set by the researchers. Another important limitation of this study was that only 2 health care professionals evaluated the videos, and the results were obtained only after the evaluation. This might significantly affect the validity of the results. Future studies can increase the number of samples by using more key words in different languages.

This descriptive study evaluated the content and quality of online videos about ostomy pouch changes. The majority of videos were accurate, and most videos were uploaded by universities, professional societies, or health care professionals. Based on these findings, the authors suggest that health care professionals can direct patients and caregivers to these online sources to obtain accurate information during the postoperative period.

Zeynep Temiz, PhD¹; and Didem Kandemir, PhD²

¹Artvin Çoruh University Faculty of Health Sciences, Artvin, Turkey
²Glasgow Royal Infırmary Hospital, Glasgow, United Kingdom

POTENTIAL CONFLICTS OF INTEREST: none disclosed

Address all correspondence to: Zeynep Temiz, PhD, Assistant Professor, Artvin Çoruh University, Faculty of Health Sciences, Nursing Department, Turkey, City Campüs, Çayağzı District, Center/Artvin; tel: +90 466 215 10 00/2134; email: erzeynep_@artvin.edu.tr