Social Media and Men's Health: Current State and Strategies for Improving Physician Impact

By: Stacy Loeb, MD, MSc, PhD(hc); Hossein Sadeghi-Nejad, MD, FACS; Christopher Warren, MD | Posted on: 01 Jun 2021

Rapid Growth in Social Media Use

Social media include networks and technologies that allow sharing of information. Up to 72% of U.S. adults use social media as of February 2021, an upward trend that involves not only younger age groups, but also adults over the age of 65 with 45% using at least 1 social media site.¹ Among practicing urologists and urology trainees, global surveys show use by 87.9% and 99.4%, respectively.^2,3 The wide adoption of these networks highlights their potential as a forum for engaging with patients, colleagues and other stakeholders.

The Upside

Social networks have great potential in further advancing clinical care, research and education related to men’s health. All of the major urological meetings have a presence on social media, allowing broader dissemination of important new research and practice updates to a global audience. Urologists are increasingly using these networks for clinical crowdsourcing and live case discussions that can provide valuable global insights for managing challenging clinical scenarios.

These networks are also valuable for research dissemination and education about major men’s health issues. The Twitter-based prostate cancer journal club, which discusses a new publication every month over a 48-hour period, is a relevant example. Unlike traditional journal clubs typically limited to a single department, Twitter-based journal clubs offer the possibility for global multidisciplinary participation. Social media, especially Twitter, were a major factor in the success of online resident education during the COVID-19 pandemic. The EMPIRE urology series hosted by the New York Section of the AUA and the Urology Collaborative Online Video Didactics, a multi-institutional lecture series featuring speakers from 35 different institutions, highlight the tremendous power of social media in “recruiting” viewers and advancing education.

The Downside

Numerous studies have highlighted the variable quality of information on social networks. A recent review of studies assessing the reliability of YouTube videos on men’s health topics found that the majority of the videos were unreliable, with only a few studies finding mostly reliable information on their chosen topic (see Table).⁴ As an example, a study on prostate cancer videos demonstrated that among the first 150 YouTube videos featuring prostate cancer, the benefits of treatment were more commonly presented than the harms. Importantly, more than three-quarters of these videos reaching more than 6 million viewers contained biased and/or inaccurate content either within the video itself or in the accompanying comments. Other instances of inaccurate or unreliable information presented in the same review paper include erectile dysfunction, male infertility, benign prostatic hyperplasia and male hypogonadism (see Table).

Table. Summary of selected research on men’s health information on YouTube⁴.

Author (Year)	Disease Studied	Key Findings	Reliability Method Used	Score
Gul et al (2019)	Premature Ejaculation	Majority of videos contained reliable information No significant association between number of views and reliability Videos created by physicians and professional organizations were more reliable Subset of videos recommended dangerous treatment options	DISCERN Score Criterion (average)	2.55 out of 5 (Reliable Group) 0.25 out of 5 (Unreliable Group)
Fode et al (2020)	Erectile Dysfunction	Majority of videos were unreliable No significant association between number of views and reliability Videos created by medical institutions were more reliable (p=.0002) Videos that advertised a specific treatment product were less reliable (p=.0001)	DISCERN Score Criterion (median)	2.0 out of 5
Ku et al (2020)	Male Infertility	Graded videos into four categories A, B, C, and D (A highest, D lowest) based on content density score Majority of videos were created by health care organizations Minority of videos received the highest grade Highest grade only went to health care providers/organizations	Content Density Score (from questionnaire based on AUA best practices)	A=4 videos B=17 videos C=12 videos D=9 videos
Preliminary study by authors	Peyronie’s Disease	Majority of videos were of acceptable quality as a patient education resource About ¾ of videos featured a board-certified urologist No significant difference in reliability score between videos featuring physicians and those that did not Videos featuring physicians had less views on average than videos that were not (p=.037)	DISCERN Score Criterion (average)	3.1 out of 5
Warren et al (2021)	Male Hypogonadism	Majority of videos were unacceptable as a patient education resource Videos featuring physicians were more reliable (p<0.01) but had fewer average views than videos that did not	DISCERN Score Criterion (average)	2.4 out of 5
Loeb et al (2019)	Prostate Cancer	More YouTube videos described benefits than harms YouTube videos with worse information were viewed more than videos with better information YouTube videos posted by physicians and professional organizations contained higher quality information but were viewed less than videos posted from other sources The majority of videos studied contained potentially biased or misinformative content within the video or comment section	DISCERN Score Criterion (median)	3.0 out of 5
Betschart et al (2020)	Benign Prostatic Hyperplasia	Majority of videos were created by health care professionals but also had commercial bias and provided inaccurate information Most prevalent topic was the overall treatment procedure Only videos covering bipolar enucleation, holmium enucleation, TURP, and patient education videos had an acceptable median reliability score	DISCERN Score Criterion (median)	2.0 out of 5

The quality of urological health content and information on social networks other than YouTube is similarly suboptimal. We recently examined TikTok videos on prostate cancer and noted that most included casual content designed to raise awareness or share a story without factual information. Disappointingly, nearly half of the 17% with “objective information” contained misinformation.⁵

Strategies for Physicians

Patients who perceive worse communication with their physician are more likely to seek health information on social networks. Due to the critical importance of the patient-physician relationship, we advocate greater emphasis on communication skills throughout medical education.

The time constraints of the encounter familiar to clinicians in busy clinical practices and the increased acceptance of telehealth are a call to urologists for creating audiovisual content that address the most common questions related to men’s health office visits and procedures. This will in turn provide clinicians with a reliable source for referring patients outside of the clinical encounter and reach a broad audience. For example, a recent study looking at the impact of 6 videos created by a large university-based health system found that their videos reached more than 600,000 viewers across 47 different countries.⁶ All practicing urologists should expect that their patients will seek additional information through the internet and that there is a significant risk of exposure to misinformation. Therefore, urologists should be proactive in directing patients and their families to high quality content that may be created by themselves or other reliable sources (eg Urology Care Foundation, Prostate Cancer Foundation, Sexual Medicine Society of North America). The content should be regularly updated to consider the rapidly evolving field and culturally appropriate for diverse audiences. It should also be free of jargon and created at the recommended reading level for consumer health information. Free resources through the YouTube Creator Academy are available to help content creators with this process.⁷

Pew Research Center: Social Media Fact Sheet. Pew Research Center 2021. Available at https://www.pewresearch.org/internet/fact-sheet/social-media/. Accessed April 10, 2021.
Dubin JM, Greer AB, Patel P et al: Global survey of the roles and attitudes toward social media platforms amongst urology trainees. Urology 2021; 147: 64.
Dubin JM, Greer AB, Patel P et al: Global survey evaluating drawbacks of social media usage for practising urologists. BJU Int 2020; 126: 7.
Warren CJ, Sawhney R, Shah T et al: YouTube and men’s health: a review of the current literature. Sex Med Rev 2021; 9: 280.
Xu AJ, Taylor J, Gao T et al: TikTok and prostate cancer: misinformation and quality of information using validated questionnaires. BJU Int 2021; doi:10.1111/bju.15403.
Zaila KE, Osadchiy V, Anderson AS et al: Popularity and worldwide reach of targeted, evidence-based internet streaming video interventions focused on men’s health topics. Transl Androl Urol 2020; 9: 1374.
YouTube: YouTube Creator Academy, Video Series. YouTube 2021. Available at https://creatoracademy.youtube.com/page/course/get-discovered?hl=en. Accessed April 03, 2021.