ANALYSIS OF THE QUALITY AND RELIABILITY OF YOUTUBE VIDEOS ON FOOT SELF-CARE FOR PEOPLE WITH DIABETES MELLITUSABSTRACT
Objective: to analyze the quality and reliability of educational videos on foot self-care for people with diabetes available on YouTube.
Method: a benchmarking study was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist in January 2025. The quality and reliability of Brazilian videos available on YouTube about foot self-care for people with diabetes, based on the guidelines of the International Working Group on the Diabetic Foot (IWGDF), were evaluated using the DISCERN and JAMA instruments. Data were analyzed using Jamovi® software version 2.3.28.
Results: a total of 20 videos were included, all of which provided guidance on foot injuries and their consequences. Most were produced by healthcare professionals, and none addressed all the IWGDF recommendations. The information identified was: foot washing (17; 85%), proper nail trimming (15; 75%), foot inspection (14; 70%), proper footwear use (14; 70%), careful drying between the toes (12; 60%), and use of emollients to moisturize the skin (12; 60%). As a result, 12 videos (60%) in DISCERN presented minimal flaws, six (30%) potentially relevant flaws, and two (10%) serious or widespread flaws. All videos evaluated in JAMA scored one in authorship, transparency, and updating and zero in attribution, thus totaling three points.
Conclusion: it is concluded that most of the evaluated videos presented high quality and partially sufficient reliability. The need to produce quality and reliable videos which cover all the self-care guidelines for the feet of people with diabetes is evident.
DESCRIPTORS:
Diabetic foot; Diabetes Mellitus; Self-care; Prevention; Educational film and video; Internet
RESUMO
Objetivo: analisar a qualidade e confiabilidade dos vídeos educacionais sobre autocuidado com os pés para pessoas com diabetes disponíveis no YouTube.
Método: estudo de benchmarking, realizado conforme as recomendações do checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses em janeiro de 2025. Avaliaram-se qualidade e confiabilidade dos vídeos brasileiros disponíveis no YouTube sobre o autocuidado com os pés de pessoas com diabetes, baseadas nas diretrizes do International Working Group on the Diabetic Foot, disponíveis no YouTube, por meio dos instrumentos DISCERN e JAMA. Os dados foram analisados por meio do software Jamovi® versão 2.3.28.
Resultados: foram incluídos 20 vídeos e todos orientavam sobre lesões nos pés e suas consequências. A maioria foi realizada por profissionais de saúde e nenhum contemplou todas as recomendações do IWGDF. As informações identificadas foram: lavagem dos pés (17; 85%), corte adequado de unhas (15; 75%), inspeção dos pés (14; 70%), uso adequado do calçado (14; 70%), secagem cuidadosa entre os dedos (12; 60%) e uso de emolientes para hidratar a pele (12; 60%). No DISCERN, doze vídeos (60%) apresentaram falhas mínimas, seis (30%), falhas potencialmente relevantes e dois (10%) falhas graves ou generalizadas. No JAMA, todos pontuaram um em autoria, transparência e atualização e zero em atribuição, totalizando, assim, três pontos.
Conclusão: conclui-se que a maioria dos vídeos avaliados apresentou qualidade alta e confiabilidade parcialmente suficiente. Evidencia-se a necessidade de produção de vídeos de qualidade e confiáveis, que contemplem todas as orientações de autocuidado com os pés para pessoas com diabetes.
DESCRITORES:
Pé diabético; Diabetes Mellitus; Autocuidado; Prevenção; Filme e vídeo educativo; Internet
RESUMEN
Objetivo: analizar la calidad y fiabilidad de los vídeos educativos sobre el autocuidado de los pies para personas con diabetes disponibles en YouTube.
Método: se realizó un estudio comparativo según las recomendaciones de la lista de verificación PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) de enero de 2025. La calidad y fiabilidad de los vídeos brasileños disponibles en YouTube sobre el autocuidado de los pies para personas con diabetes, basados en las directrices del International Working Group on the Diabetic Foot (IWGDF), se evaluaron mediante los instrumentos DISCERN y JAMA. Los datos se analizaron con el software Jamovi® versión 2.3.28.
Resultados: se incluyeron veinte vídeos, todos ellos con información sobre lesiones en los pies y sus consecuencias. La mayoría fueron producidos por profesionales sanitarios y ninguno abordó todas las recomendaciones del IWGDF. La información identificada fue: lavado de pies (17; 85%), corte adecuado de uñas (15; 75%), inspección de pies (14; 70%), uso adecuado de calzado (14; 70%), secado cuidadoso entre los dedos (12; 60%) y uso de emolientes para hidratar la piel (12; 60%). En DISCERN, doce videos (60%) presentaron fallas mínimas, seis (30%) fallas potencialmente relevantes y dos (10%) fallas graves o generalizadas. En JAMA, todos obtuvieron una puntuación de uno en autoría, transparencia y actualización, y cero en atribución, sumando así un total de tres puntos.
Conclusión: se concluye que la mayoría de los videos evaluados presentaron alta calidad y una fiabilidad parcialmente suficiente. Es evidente la necesidad de producir videos de calidad y fiables que abarquen todas las pautas de autocuidado para los pies de las personas con diabetes.
DESCRIPTORES:
Pie diabético; Diabetes Mellitus; Autocuidado; Prevención; Película y video educativo; Internet
INTRODUCTION
Diabetic foot disease is a complex, preventable condition fraught with suffering and financial costs for the patient, with a significant impact on quality of life, as well as affecting family, professionals, health systems and society in general1. The prevalence of foot ulcers in people with diabetes is 6.3% worldwide, with the highest prevalence in North America, 13%, and the lowest in Oceania, 3%. The prevalence in Africa is 7.2%, higher than in Asia (5.5%). Foot ulcers in people with diabetes is more prevalent in men (4.5%) than in women (3.5%). In addition, people with type 2 diabetes mellitus (DM2) have a higher prevalence of ulceration (6.4%) compared to people with type 1 diabetes mellitus (DM1) (5.5%)2. Amputations and death can occur in more severe cases. A study conducted at a high-complexity hospital in Northeast Brazil showed that patients with diabetes mellitus (DM) undergoing lower limb amputation had a high prevalence of surgical site infection. It was also found that the occurrence of these infections was significantly associated with low family income and prolonged hospital stay3.
Thus, the impact on patients and the cost of diabetic foot disease can be considerably reduced when evidence-based preventive treatment is implemented in people with diabetes who are at risk of developing foot ulcers1. Prevention of diabetic foot disease is fundamental to reducing risks and complications, preserving quality of life, and reducing treatment costs4.
Among the prevention forms, regular assessment focused on screening, risk classification, early treatment, and self-care practices can ensure effective systematic care actions5-7. Self-care is considered to be the practice of activities that the individual performs for their own benefit in the maintenance of life, health, and well-being8, which should be encouraged through education.
In turn, patient education is an important component of care and plays an essential role in disease management, health promotion and prevention of complications, contributing to self-care and reducing complications9. It should be presented in a structured, organized and repeated manner to achieve significant performance in injury prevention, improving patient self-care of the feet and increasing motivation and skills for adherence to treatment1.
Patient education can take many forms, such as individual verbal education, education integrated with motivational interviews, group educational sessions, video education, booklets, software applications, questionnaires, and pictorial education through cartoons or descriptive images1. Educational videos stand out in this context, which are audiovisual tools for the rapid dissemination of information through online platforms that enable access to anyone, regardless of social class or educational level10.
Considering YouTube as the most widespread site among Internet users, which leads many people to use it as a research source, the importance of research which analyzes the quality and reliability of the information posted is emphasized11. Furthermore, YouTube is one of the most important tools for disseminating information due to its ease of access and transmission of the message in video or audio format, becoming one of the main sources of data transmission in the world12. Therefore, the importance of disseminating adequate self-care guidelines for the feet to prevent complications in people with diabetes is highlighted. In this sense, by acting as a disseminator of information, YouTube is significantly important in spreading knowledge, becoming a favorable place for investigating the object of study.
Given the above, this study aimed to analyze the quality and reliability of educational videos on foot self-care for people with diabetes available on YouTube.
METHOD
This is a benchmarking study conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist13 used in systematic reviews. To this end, the following steps were adapted for this study: 1) Establishing the analytical objectives; 2) Choosing the terms; 3) Enumerating the criteria; 4) Defining the information to be extracted; 5) Analyzing the results; and 6) Presenting the results and discussing.
The analytical objectives were initially established, which were to identify and quantify the videos available on YouTube about foot self-care for people with diabetes. The selection of videos occurred in a single data collection session, on January 5, 2025.
The terms were chosen in the second stage, defining the following terms according to the Health Sciences Descriptors (DeCS): Feet and diabetes, Diabetic foot, Foot self-care, used in combination and with quotation marks, to restrict the search to videos that had both descriptors. The search was conducted up to page ten, where the videos were related to the search. The titles and descriptions of the videos were analyzed for the pre-selection to assess whether they addressed the study objective.
Next, the inclusion and exclusion criteria for the videos were considered for the third stage. Videos on foot self-care for people with diabetes aimed at patients and/or family members, in Brazilian Portuguese, were included. Videos divided into more than one part, live streams, shorts, advertisements, and those with low image and sound quality were excluded, as this could interfere with the evaluation process.
In turn, the information to be extracted was defined in the fourth stage. The data collection was carried out in pairs, independently, with the aid of a specific form with information divided into four parts: 1) General characteristics: Type of filming, Authorship, Title, Entity that posted, Category, Posting date, Duration, Number of views, Number of comments, User rating; 2) Self-care guidelines for the feet, according to the recommendations of the International Working Group on the Diabetic Foot (IWDGF)1. This institution has been publishing practical guidelines since 1999 based on systematic literature reviews and the formulation of evidence-based recommendations from multidisciplinary experts worldwide on the prevention and management of diabetic foot diseases14, namely: Foot inspection, foot washing, careful drying between the toes, nail trimming, use of emollients to lubricate the skin, no use of chemical agents or plasters to remove calluses, footwear inspection, avoiding walking barefoot or only with socks or thin-soled slippers, avoiding wearing tight socks, avoiding exposure to excessive cold and heat); 3) The DISCERN instrument was used for video classification, which classifies the quality of health information related to the treatments provided in the videos15.
The instrument consists of 16 questions divided into three sections. The first section (8 questions) assesses the reliability of the information or the credibility of the information source; the second (7 questions), the quality of information on treatment options; and the last (1 question), the overall quality of the publication. Sections 1 and 2 are evaluated using a five-point Likert scale: 1 - no; 2; 3 - partially; 4 and 5 - yes; and, in section 3, the response options are 1 - Low (serious or widespread flaws); 2; 3 - Moderate (potentially important but not serious flaws); 4 and 5 - High (minimal flaws).
The questions in section 2 refer to the treatment or treatments described in the publication; self-care was considered a form of treatment throughout this section15. The Journal of American Medical Association Benchmarks (JAMA Benchmarks) tool16 was used to measure reliability, specifically to determine authorship, attribution, transparency, and timeliness of the videos. Authorship is linked to the identification of the authors and contributors of the electronic site, their credentials, and affiliations. Attribution covers the references and sources of information. The concept of transparency is linked to the identification of the site owner, sponsorship, advertising policies, and possible conflicts of interest. Timeliness refers to the presentation of publication and update dates of information16,17. The total is calculated from the sum of the scores assigned to each item, resulting in a value ranging from 0 to 4, classified as: 0 to 1 - insufficient data, 2 to 3 - partially sufficient data, and 4 - sufficient data16,18.
The difference in the results obtained from using the two evaluation instruments is explained by the fact that JAMA evaluates the reliability of the videos without taking into account the content presented17. The data collection was conducted by two researchers and corroborated by a third, so that any differences in approach and focus were always discussed and resolved with complete agreement.
Then, the results were analyzed in the fifth stage using Jamovi® software version 2.3.28. Absolute and relative frequencies were used for qualitative variables, while normality was first calculated for quantitative variables using the Shapiro-Wilk test, adopting the null hypothesis (variables follow a normal distribution) for p > 0.05 and the alternative hypothesis (variables do not follow a normal distribution) for p < 0.05. Mean and standard deviation were used for variables that presented a normal distribution. Asymmetrical variables were represented by the median and percentile. Self-care guidelines based on the IWGDF1 were presented using the absolute and relative frequencies of the yes, no, and partly responses.
Furthermore, the DISCERN results were represented by the relative and absolute frequencies of the final video quality rating, obtained from the sum of the points for each item of the instrument. In turn, the mean and standard deviation of the item and total scores obtained for each video were used for JAMA.
Finally, the correlation between the variables video duration (in seconds), number of views, number of channel subscribers, number of comments, and DISCERN rating was tested using Spearman’s Correlation Coefficient, since they did not follow a normal distribution, with statistical significance considered at p-value < 0.05. The strength of the correlation was considered greater when the result of the calculation was closer to the extremes (-1 or +1) and weak or non-existent when close to 0, with positive values being directly proportional and negative values inversely proportional.
The authors did not use text generation tools and/or Artificial Intelligence (AI) during the preparation of this article. This study was not submitted to the ethics committee because it was conducted on a social network and did not involve any patient or human data, other than measuring internet activity among YouTube users. In addition, only data from users who consented to YouTube making their data publicly available were used (i.e. no privacy settings were selected by them). Even so, individual user accounts were anonymized to develop good research practices in social media19. Finally, the presentation of results and discussion (sixth stage) was conducted in a descriptive manner and with figures and tables.
RESULTS
The initial search identified 54 videos. After reading the titles and descriptions of the videos, all 54 remained for full evaluation. However, 34 were excluded in this process because they did not address self-care guidelines for feet for people with diabetes directed at patients and/or family members (n=33), or because they were not in Brazilian Portuguese (n=1), leaving 20 videos to compose the final sample of the study (Figure 1).
Of the 20 videos included in the study, 16 (80%) were professional recordings. Regarding authorship, seven (35%) were produced by doctors, three by nurses (15%), and two each by physiotherapists (10%), an institute (10%), and news reports (10%). The remaining videos were made by nutritionists, patients, the health department, and a society or association, one each.
The year of posting ranged from 2012 to 2024, with the period between 2021 and 2024 being predominant (9.45%), suggesting that the videos contain up-to-date information. All had people with DM and their families as the target audience. The median video duration was 5.46 minutes, the number of views was 7,330, the number of channel subscribers was 30,600, and the number of comments was 16 (Table 1).
All videos provided guidance on foot injuries and their consequences (20; 100%). The main self-care guidelines for feet identified were: washing feet (17; 85%), proper nail trimming (15; 75%), foot inspection (14; 70%), proper footwear use (14; 70%), careful drying between the toes (12; 60%), and use of emollients to moisturize the skin (12; 60%). In contrast, most videos did not provide information regarding the non-use of chemical agents or plasters to remove calluses (13; 65%) and footwear inspection (13; 65%) (Table 2).
Content covered regarding guidelines for self-care practices for the feet of people with diabetes. Fortaleza, CE, Brazil, 2025. (n=20)
Some videos addressed incomplete or even erroneous guidelines on foot self-care, such as: images of characters with their feet in a basin of water (n=2); putting your hand in to test the water temperature while bathing (n=2); seeking a health professional for a foot massage after physical exercise (n=1); using antiseptic powders on feet that sweat excessively (n=1); using lotions and powders between the toes (n=1); sitting with feet elevated to improve venous return (n=1), without specifying contraindications; and advising the use of a foot file to remove calluses (n=1).
Regarding the quality of information in the videos, 12 (60%) had minimal flaws, six (30%) had potentially relevant flaws, and two (10%) had serious or widespread flaws. All vidoes in JAMA scored one in authorship, transparency, and updating, and zero in attribution, totaling three points. Thus, all presented partially sufficient data (Table 3).
Only the correlations between the number of views and the number of comments; the number of views and the number of user ratings; and the number of comments and the number of user ratings showed statistical significance (p < 0.05), all being strong correlations. Thus, it is suggested that the greater the number of views, the greater the number of comments and user ratings. Furthermore, the number of user ratings tends to increase when the number of comments increases (Table 4).
DISCUSSION
Educational video recordings are increasing in popularity. They are available on various platforms, and do not always undergo an evaluation process20,21. Although educational videos are quite prevalent, it is noteworthy that our study is the first in the literature to evaluate the quality and reliability of YouTube videos in Brazilian Portuguese, according to the IWGDF (2023) foot self-care recommendations1.
Regarding the prevention of complications in chronic diseases, foot self-care guidelines for people with diabetes can prevent negative outcomes such as limb amputation, which impact patients’ quality of life22. In this context, educational videos can constitute an important strategy for strengthening health education; however, for this to occur, it is necessary to comply with methodological rigor23,24. In turn, the filming quality becomes a relevant factor, since the main difference between professional and amateur productions lies in the resources used in their elaboration, such as the use of advanced cameras and software. Professional productions are produced and edited by technical experts; amateur productions use simpler resources in their production25. The type of filming can interfere with the reception of the content by the target audience, as demonstrated by a study26 that evaluated 288 videos and identified that amateur productions scored significantly lower in the technical and instructional domains compared to professional ones, which can prevent viewer engagement.
Video duration must be considered for it to be high quality, which is an essential parameter when planning the creation and consumption of a video on YouTube27. There is no single guideline regarding the ideal duration of educational videos. However, there is greater acceptance by the public when videos do not exceed five minutes14.
This acceptance process can contribute to generating a conflict between scientific content and the logic of digital algorithms, which favors visibility of simplistic content to the detriment of scientific materials28. Thus, even when high-quality educational videos are produced by professionals and experts, algorithmic dynamics can limit their reach; this is in contrast to persuasive content that spreads more quickly and in greater quantities, which can represent a risk to the public dissemination of knowledge and health29. In addition to having a large social impact, many patients in regions with barriers to access to healthcare use YouTube as their main or only educational resource30.
Authors must pay attention to technical and instructional elements during filming to ensure engagement of the target audience and proper absorption of the information transmitted. A video should present aspects such as production quality, content visualization, appropriate explanation pace, technical accuracy and completeness, using examples and linking content to prior knowledge to ensure an engaging communication style related to the video content and the suitability of the format for educational purposes27.
A significant correlation was found in this study between the number of views and the number of comments and ratings from internet users, and between the number of comments and the number of ratings from internet users. According to Lijo et al. (2024)27, the more visible content is, the more visits and interactions, such as comments, shares and likes, it receives.
The present study showed that although the videos analyzed addressed self-care guidelines for feet of people with diabetes, there are significant differences in terms of quality and reliability. The materials are similar in terms of daily foot inspection and glycemic control, which are strongly recommended in the IWGDF1. However, none of them fully addressed all the self-care guidelines presented in the guideline, highlighting a gap in the content.
The videos also differed in terms of clarity of messages, level of technical detail, and evidence-based content. While some presented accessible language transmitted with good image and sound quality, others were incomplete or confusing, with scripts marked by brief segments or with unknown foundations. The reliability of this material, assessed according to JAMA16 criteria, is questioned by the absence of references and sources used. Furthermore, even those produced by health professionals obtained scores with considerable variance in content organization and depth of information, as shown in the scores obtained by DISCERN.
The results of this study demonstrate that even videos with good technical quality can present content which does not correspond to scientific evidence. It is worth highlighting that the IWGDF1 recommendations help healthcare professionals provide better care for people with diabetes at risk of foot ulcers, increase the number of ulcer-free days, and reduce patient and healthcare costs due to diabetes-related foot disease31. Prevention, as well as diabetes management, is associated with a decrease in diabetes-related lower extremity amputations14, corroborating the importance of disseminating guidelines appropriately, with technical support based on scientific evidence.
Similar to the data found, a study that evaluated the quality of YouTube videos on adhesive capsulitis showed that videos from medical or academic sources did not provide more educational information than other sources32. Furthermore, other research has also shown the low quality of information communicated by YouTube for educational use in various diseases12,33. In contrast, recent studies have shown that videos created by health professionals are generally more detailed and of greater educational value and quality34,35; however, some videos were still classified as low-to-moderate quality34.
This data deserves attention, as a study conducted with YouTube users revealed that a significant majority are making health decisions based on what they watch, with 15.7% doing so even more frequently. This demonstrates that YouTube can influence the health of those who consume health-related videos and that people are making decisions based on what they watch36. As a result, the importance of developing educational videos with methodological rigor, with content based on scientific evidence and in language understandable to people is evident.
It is clear that there is still no official curation by the Unified Health System (Sistema Único de Saúde - SUS) or scientific societies regarding reliable educational videos or incomplete information37. In addition, the training of health professionals contributes little to producing digital content that integrates logical narrative, accessible language in a short and limited time. Therefore, even videos made by professionals may lack clarity, engagement or completeness38.
Considering that almost all videos were made by professionals, the DISCERN assessment of the quality of information indicates that it is still necessary to improve the quality of health information related to foot self-care for people with diabetes by professionals. This also means that there is a large amount of unverified information being shared by people who do not identify themselves as health professionals and do not base their statements on scientific sources. This situation can affect people and become a public health problem12.
Regarding reliability, none of the available videos provided attribution, which includes the references and resources used for the content (which should be clearly listed), as well as copyright information referenced according to JAMA Benchmarks criteria. However, information on authorship, transparency, and the videos’ recency was provided.
The internet has made it easier than ever to access information on any imaginable subject. However, this also means that a lot of information and misinformation is available online, which can be a problem because people may not be able to distinguish between reliable and unreliable information32.
The quality and reliability of health-related content information can vary significantly. This discrepancy between popularity and content quality highlights the challenge of ensuring the availability and accessibility of reliable, high-quality health-related videos on the platform36. Although the educational videos available cover important topics, we were unable to find any video that covered all the foot self-care recommendations recommended by the IWGDF1.
By systematically evaluating the quality and reliability of YouTube videos on foot self-care in people with diabetes, our study highlights gaps in the available information and underscores the importance of evidence-based digital content and reliable sources. Therefore, it contributes to providing support to health professionals and diabetes educators, guiding the production of reliable educational materials on the internet and highlighting the usefulness of instruments that assist in assessing the quality and reliability of information. Our study has some limitations, such as the difficulties of searching within YouTube, since many videos different from the searched subject appeared even with the use of various search strategies focused on the topic. Another limitation is that the videos were viewed and evaluated at an opportune moment; however, the number of views, likes, and comments on videos is prone to change.
CONCLUSION
When analyzing the quality and reliability of educational videos on foot self-care for people with diabetes available on the YouTube platform, most presented high quality with minimal flaws, and demonstrated partially sufficient data.
Although most videos published on YouTube about foot self-care guidelines for people with diabetes are published by healthcare professionals, they present information that is not aligned with the scientific literature or with incomplete information. Thus, the importance of improving the reliability and quality of the content is noted so that internet users can find educational videos with reliable information in an understandable language.
It is therefore suggested that high-quality and reliable videos on foot self-care for people with diabetes be produced and that studies be conducted to evaluate these characteristics for availability on digital platforms, such as YouTube.
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NOTES
Edited by
The dataset supporting the results of this study is available upon request from the corresponding author.
