Quality and Reliability of Neonatal Hypoxic-Ischemic Encephalopathy Related Short Videos on Douyin and Bilibili: A Cross-Sectional Content Analysis in Mainland China

Quality and Reliability of Neonatal Hypoxic-Ischemic Encephalopathy Related Short Videos on Douyin and Bilibili: A Cross-Sectional Content Analysis in Mainland China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Quality and Reliability of Neonatal Hypoxic-Ischemic Encephalopathy Related Short Videos on Douyin and Bilibili: A Cross-Sectional Content Analysis in Mainland China Jintao Wei, Yeyu Li, Jing Yang, Lirong Guan, Xue Wang, Ying Yuan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8449515/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Hypoxic-ischemic encephalopathy (HIE) poses severe threats to neonates, with long-term neurological sequelae. Social media like Douyin and Bilibili has become vital for HIE health education, but misinformation risks exist. However, no studies have evaluated HIE-related video quality on these mainland China platforms, highlighting an urgent research gap. Method From September 20–30, 2025, 200 top HIE-related videos (100 each from Douyin and Bilibili) were collected via new accounts. Videos were classified by source and content, then assessed using GQS and mDISCERN scales. Statistical analyses included Mann–Whitney U test, ANOVA, and Spearman correlation. Results Bilibili videos had longer duration and higher GQS and mDISCERN scores than Douyin. Douyin showed higher user engagement. Neonatologists’ videos and disease knowledge and treatment content scored significantly higher in quality and reliability than patient-shared content. Conclusion Bilibili provides higher-quality, more reliable HIE information, while Douyin focuses on interactive lightweight content. Medical professionals, platforms, and creators must collaborate to enhance medical information quality, ensuring accurate HIE knowledge dissemination for public health benefit. Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Hypoxic-ischemic encephalopathy (HIE) is a brain injury that occurs due to hypoxia and reduced cerebral blood flow, and consequently leads to mortality as well as long-term neurological sequelae.[ 1 ] Newborns with HIE exhibit significant acidosis, which reflects recent hypoxic-ischemic insult—alongside clinical signs of neonatal encephalopathy, such as reduced consciousness or poor muscle tone. Survivors of HIE may go on to develop long-term disabilities, including cerebral palsy and cognitive impairment.[ 2 ] In developed countries, the incidence rate of HIE is 2 to 3 cases per 1000 neonates; in developing countries, this rate reaches 26 cases per 1000 neonates. Of these asphyxiated neonates with HIE, approximately 10% to 15% die during the neonatal period, and an additional 25% to 30% develop long-term sequelae. [ 3 ] The most common cause of hypoxic injury is intrauterine asphyxia, which is triggered by circulatory disorders, such as placental artery clotting, placental abruption, or inflammation. These issues lead to perinatal depression, subsequently reducing oxygen-carbon dioxide exchange and causing severe lactic acidosis.[ 4 ] The only effective treatment for HIE is therapeutic hypothermia, which has reduced the mortality rate of HIE from 25% to 9% and the mortality rate among infants with severe disabilities from 20% to 16%. However, although there is a reduction in cerebral palsy, cognitive impairment remains a significant issue. [ 5 ] HIE not only causes significant harm to the infants themselves but also imposes severe burdens on their families and society. Therefore, it is crucial to achieve early detection of HIE, reduce its incidence, and improve treatment outcomes. Since rooming-in for mothers and infants was first implemented in maternity wards around 1947, rooming-in with newborns has now been widely accepted. Rooming-in helps create a caring hospital environment, where family members can establish emotional bonds with newborns earlier.[ 6 ] However, it also poses challenges to medical staff. Enabling family members to achieve early identification of potential HIE in newborns is a crucial component in preventing the occurrence and progression of HIE and alleviating its adverse outcomes. Meanwhile, social media and short videos related to HIE are a promising patient education tool. Social media is increasingly used in public health education as it breaks down physical barriers that long blocked access to healthcare support and resources. The public and healthcare professionals can communicate about health issues via social media, which may improve health outcomes. Previous research shows health information dissemination can change individuals’ health behaviors, greatly improving early disease diagnosis and prevention. However, some non-professionals, may use social media to communicate and share information, which may spread misinformation. [ 7 ] Numerous studies have shown that compared with other methods, videos are more effective in disseminating health information due to their engaging nature, visual appeal, and ability to explain complex concepts. In recent years, short videos have gained immense popularity and exerted an impact on people's lives. Among various topics on short video platforms, health-related topics have grown extensively; currently, short videos have become a powerful tool for providing health advice and influencing people's health beliefs and behaviors.[ 8 ] Within the Chinese mainland, Bilibili and Douyin hold a prominent position among social media platforms centered on video content. Bilibili, a video-sharing platform widely favored by young people in China, provides users with abundant video resources and boasts a daily active user base of 107 million. As the Chinese domestic version of TikTok, Douyin has over 750 million daily active users and ranks among the top-tier applications in China in terms of popularity. [ 9 ] On these platforms, users can freely access a large number of health-related videos by searching for keywords such as "HIE". Meanwhile, users have multiple ways to engage with the content, including leaving comments, giving likes, and using other interactive functions. [ 10 ] However, the potential inaccurate or false information contained within them is highly misleading. It may lead to the widespread spread of such misinformation, thereby exerting a negative impact on public health. [ 11 ] Although Douyin and Bilibili contain videos related to HIE, no research has yet been conducted to evaluate the quality of videos related to HIE on short-video sharing platforms in Chinese mainland. Therefore, the purpose of this study is to conduct a detailed analysis of the quality of HIE-related videos accessible on Douyin and Bilibili. Method Search Strategy and Data Collection Methods The search was conducted on Bilibili and Douyin from September 20 to September 30, 2025. To avoid bias caused by personalized recommendations, a new account was registered on both platforms, and searches were performed using the keywords "新生儿缺氧缺血性脑病"“新生儿缺血缺氧脑病” (HIE in Chinese). No other filtering criteria were applied to restrict the search. These videos were organized by the algorithms of Bilibili and Douyin. Prior research has demonstrated that most users primarily focus on the top content in online search results.[ 12 ] Therefore, only the top 100 relevant videos for each keyword on each platform were selected, and videos that met the following exclusion criteria were omitted: less than 1 week, duplication, advertisements, irrelevant content, pictures only, silent content and non-Chinese content. We collected the videos' source, duration, upload date, content, and the number of likes, comments, collections, shares, and views from users on September 30, 2025. Since Douyin does not publicly disclose video view counts, we did not include these metrics in our statistics. Search strategy for short videos on HIE Video Classification Process Based on their source and content, the videos were each classified into four categories. Regarding video sources, the categories include neonatologists, other science communicators, patients. For video content, the categories are disease knowledge, disease treatment, case and experience sharing. Quality and Reliability Assessment of Video All searches were conducted on public computers. Before conducting the searches, all settings and browsing history on the computers were cleared, and cookies were disabled during the search process to prevent any impact on the data. To assess the quality and reliability of video content, two widely used standardized scales, the GQS and mDISCERN, were utilized. The Global Quality Scale (GQS) is a five-point Likert scale that subjectively assesses videos’ overall quality, structure, and informational completeness, and is frequently employed to measure the synergy between information delivery and platform usability.[ 13 ] The modified DISCERN (mDISCERN) tool, which is designed to evaluate the credibility of online health information, utilizes five equally weighted questions to establish a structured reliability framework. [ 14 ] Typically, the GQS and mDISCERN scales were used to assess the quality of the short videos in this study, with scoring ranging from 1 (poor) to 5 (excellent). [ 15 ] Two researchers (JW, JY) independently completed the review and evaluation of all the aforementioned videos in this study. If there were inconsistencies in their evaluation results, they were rejudged and rescored by an authoritative neonatologist (YL). Statistical analysis Categorical variables were summarized as frequencies and percentages. Non-normally distributed data were described using the median and range, or interquartile range (IQR, Q1-Q3). For comparisons between two groups, the Mann–Whitney U test or Student’s t-test was used. For comparisons among three or more groups, one-way analysis of variance (ANOVA) or the Kruskal–Wallis test was applied.[ 16 ] Spearman correlation analysis was used to explore correlations among all quantitative variables. [ 17 ] Statistical significance was set at P < 0.05. IBM SPSS Statistics (Version 27.0, Windows) was used for statistical analyses, and GraphPad Prism (Version 10.4.2, Windows) was utilized for data visualization. Ethical considerations Clinical data, human specimens, and experimental animals were not involved in the present study. Instead, all data were sourced from publicly available videos on Douyin and Bilibili, thus ensuring no violations of personal privacy. Given the absence of any user interaction in this study, ethical review was not required. Results Video characteristics The present study incorporated a total of 200 videos, with an equal distribution of 100 videos sourced from each of the two platforms. As presented in Table 1, Douyin videos garnered statistically significant advantages in terms of engagement metrics, including likes, comments, saves, shares, and total view counts, when compared to Bilibili videos. Conversely, Bilibili videos exhibited a markedly longer average duration than their Douyin counterparts. Collectively, these findings indicate that Bilibili prioritizes long-form video content, while Douyin places greater emphasis on content that drives user interaction. Characteristics of the videos on Bilibili and Douyin. Characteristic Douyin, N = 100 Bilibili, N = 100 P-value Duration 58.0 (35.00, 130.50) 272.5 (123.00, 1262.75) < 0.001 Shares 119.5 (46.75, 591.00) 3.0 (0.00, 15.75) < 0.001 Likes 389.0 (133.00, 2195.25) 4.0 (1.00, 14.75) < 0.001 Comments 127.0 (17.00, 623.75) 0.0 (0.00, 1.00) < 0.001 Days since published 387.0 (233.25, 860.50) 882.0 (449.00, 1130.50) < 0.001 Video classifications When examining the characteristics of neonatal-related content across two major Chinese platforms, notable disparities emerge both in terms of upload sources and content distribution. From the perspective of video upload origins, the volume of videos posted by neonatologists (44%), other science communicators (30%), and patients (26%) on the Douyin platform is roughly equivalent, reflecting a relatively balanced contributor ecosystem. In stark contrast, Bilibili exhibits a lopsided distribution of content creators, where other science communicators dominate overwhelmingly, accounting for 73% of total uploads, while neonatologists (19%) and patients (8%) contribute a far smaller share of videos.In terms of content categories, Douyin’s content landscape is significantly more diversified: disease knowledge (47%), disease treatment (24%), and case and experience sharing (29%) all receive algorithmic promotion from the platform, indicating the platform’s strategy to cater to a broad range of information needs. On Bilibili, however, content is highly concentrated in the disease knowledge category, which constitutes 77% of all relevant videos and captures the bulk of platform traffic. By comparison, content related to disease treatment (11%) and case and experience sharing (12%) is not prioritized in the platform’s traffic allocation mechanism, highlighting Bilibili’s focus on academic and informational content over clinical guidance and personal experience sharing in the neonatal HIE field. Percentage of videos on HIE from different sources and with different contents on Bilibili and Douyin: Video quality and reliability Across the two core assessment metrics, GQS and mDISCERN, statistically significant disparities emerged between video content distributed on Douyin versus Bilibil. Quantitatively, Bilibili-hosted videos exhibited a median score of 4 for both GQS and mDISCERN—metrics that collectively signal high content quality and strong informational reliability for this platform. Conversely, Douyin’s video content returned scores of 3 for both indices, a pattern that reflects comparatively diminished quality and reliability relative to the content available on Bilibili. GQS and mDISCERN scores of videos related to HIE on Bilibili and Douyin: ****P < 0.0001 We compared GQS and mDISCERN scores across different content types and creator sources.For content types, GQS scores were no significant difference between the GQS scores of "disease knowledge" and "disease treatment". However, the GQS scores of both categories were significantly higher than that of "case and experience sharing". mDISCERN scores's trend was consistent with GQS: no significant difference existed between "disease knowledge" and "disease treatment", while both had significantly higher mDISCERN scores than "case and experience sharing", which is matching the above significance levels.For creator sources, Neonatologists had significantly higher GQS scores than other science communicators. Additionally, the GQS scores of neonatologists and other science communicators were both significantly higher than those of patients. Also, neonatologists obtained significantly higher mDISCERN scores than other science communicators. Moreover, the mDISCERN scores of neonatologists and other science communicators were all significantly higher than those of patients. No notable differences were observed among the remaining source groups. GQS and mDISCERN scores of videos on HIE from different content types on Bilibili and Douyin: (a) GQS of Bilibili videos from different content types, (b) mDISCERN scores of Bilibili videos from different content types, (c) GQS of Douyin videos from different content types, and (d) mDISCERN scores of Douyin videos from different content types. GQS: Global Quality Scale; mDISCERN: modified DISCERN. ns not significant, *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. GQS and mDISCERN scores of videos on HIE from different sources on Bilibili and Douyin: (A) GQS of Bilibili videos from different sources, (B) mDISCERN scores of Bilibili videos from different sources, (C) GQS of Douyin videos from different sources, and (D) mDISCERN scores of Douyin videos from different sources. GQS: Global Quality Scale; mDISCERN: modified DISCERN. *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. The relationship between video quality and other parameters Given that the data deviated from a normal distribution, Spearman’s rank correlation analysis was utilized to explore the associations among diverse video variables. On the Bilibili platform, multiple significant positive correlations emerged: GQS scores were strongly positively correlated with video duration (r = 0.604, P < 0.001), shares (r = 0.440, P < 0.001), likes (r = 0.240, P = 0.016), and days since publication (r = 0.200, P = 0.046). Correspondingly, mDISCERN scores exhibited significant positive correlations with video duration (r = 0.556, P < 0.001) and shares (r = 0.346, P 0.05). For the Douyin platform, both GQS and mDISCERN scores showed significant positive correlations with video duration (GQS: r = 0.294, P = 0.003; mDISCERN: r = 0.286, P = 0.004). Conversely, GQS scores were significantly negatively correlated with comment counts (r = -0.226, P = 0.024) and days since publication (r = -0.253, P = 0.011); mDISCERN scores similarly displayed significant negative correlations with comments (r = -0.213, P = 0.033) and days since publication (r = -0.208, P = 0.038). No significant correlations were observed between GQS/mDISCERN scores and shares or likes on Douyin (all P > 0.05). Spearman correlation analysis between video variables and the GQS and mDISCERN scores. *P < 0.05, **P < 0.01 Variable Bilibili (r, P-value) Douyin (r, P-value) GQS mDISCERN GQS mDISCERN Duration 0.604**, < 0.001 0.556**, < 0.001 0.294**, 0.003 0.286**, 0.004 Shares 0.440**, < 0.001 0.346**, < 0.001 0.071, 0.480 0.090, 0.372 Likes 0.240*, 0.016 0.092, 0.365 -0.154, 0.126 -0.136, 0.178 Comments -0.031, 0.758 -0.002, 0.983 -0.226*, 0.024 -0.213*, 0.033 Days since published 0.200*, 0.046 0.181, 0.072 -0.253*, 0.011 -0.208*, 0.038 Discussion Social Media and Public Health Trends In the field of public health education, the application of social media has achieved a leapfrog expansion in recent years, and this development trend is still continuing to strengthen. At its root, the widespread popularity of social media platforms is the core driving force, and such platforms are now deeply embedded in the links of health information dissemination and health science education, becoming an indispensable key medium.[ 18 ] In this context, health institutions and professional practitioners at all levels have arranged social platforms such as Douyin and Bilibili to carry out targeted science popularization and content push of health knowledge for diverse audiences.[ 19 ] However, it should be pointed out that due to the rapid iteration of social media technology and ecology, the timeliness of previous research conclusions in this field has been limited, and their conclusions may have undergone corresponding changes at this stage.[ 20 ] Dual-Platform HIE Video Quality Based on a cross-sectional analysis, this study conducted a systematic evaluation of HIE-related science popularization videos on two major platforms, Douyin and Bilibili. The results revealed statistically significant differences in content quality and information reliability between the two platforms, indicating that the overall professionalism and credibility of HIE science popularization content on Douyin were inferior to those on Bilibili. To date, little or no longitudinal follow-up studies have focused on the quality of HIE videos on Douyin. However, a cross-comparison between the data of this study and earlier research on similar health science popularization videos suggests that the overall quality of specialized disease science content on short-video platforms has not achieved substantial improvement with the evolution of platform ecosystems.[ 21 ] To explore the core causes of the suboptimal quality of HIE videos on Douyin, two key factors were identified. First, content creators on the platform are evenly distributed across groups, and non-professional creators inherently lack sufficient medical knowledge reserves.[ 22 ] Second, this issue stems from the media characteristics of Douyin’s content: HIE videos on the platform have a significantly shorter average duration and mostly focus on sharing personal diagnosis and treatment experiences, lacking systematic validation from a professional perspective.[ 23 ] Notably, the quality and reliability of HIE videos on Douyin were only positively correlated with video duration, but showed no significant association with interaction metrics such as share volume and like count. Furthermore, their quality scores were negatively correlated with comment count and publication days. This finding reveals that under the platform’s entertainment-oriented ecosystem, low-professionalism HIE science content can gain traffic attention through high interactivity, while the dissemination efficiency of high-quality content is not fully realized. Compared with science popularization by professional neonatologists, personal experiences and emotional expressions from some patient families often resonate more with the general public.[ 24 ] The above conclusions highlight the core contradiction between the professional quality of HIE science popularization videos and public engagement: high-quality medical science content struggles to translate into wide dissemination.[ 25 ] This dilemma urgently needs to be addressed to improve the ability of neonatal families to identify HIE at an early stage. In stark contrast, HIE-related videos on Bilibili have a significantly longer average duration and maintain a high overall quality level. This advantage is attributed to two aspects. On one hand, it relies on the platform’s professional-oriented content creation model—although neonatologists account for a small proportion of creators, most belong to professional science popularization groups, including practitioners from other departments (e.g., pediatricians, radiologists, basic medical scientists). Their content focuses on disease knowledge popularization, with a core emphasis on the accurate delivery of professional information such as HIE pathogenesis and early identification. [ 26 ] On the other hand, video duration on Bilibili shows a strong positive correlation with both the GQS and mDISCERN score, suggesting that sufficient duration provides a critical guarantee for in-depth interpretation of complex HIE medical knowledge, systematic citation of authoritative literature, and the establishment of a complete science popularization logic.[ 27 ] However, the high professional barriers of such content result in far lower dissemination and interaction volumes compared with Douyin. Despite their strong educational value, many videos receive little viewership and engagement due to their relatively tedious content. This is a topic requiring further in-depth exploration in future research: how to balance the scientific rigor and communicability of medical science popularization videos. [ 28 ] Patient HIE Content Value It should be further pointed out that although this study confirmed through GQS and mDISCERN scales that the content quality and information reliability scores of HIE related videos uploaded by the patient population were significantly lower than those of neonatologists and professional science popularization creators, such content still has unique value and dissemination significance that cannot be ignored in the online health information dissemination ecosystem. From the perspective of content attributes, HIE related videos created by patients often focus on personal diagnosis and treatment experiences, disease treatment processes, and emotional counseling during the illness. [ 29 ] They can provide psychological support and peer connections for families of newborns facing similar difficulties, and offer emotional comfort that professional medical science popularization content cannot cover. [ 30 ] For families of newly diagnosed children with HIE, such experience sharing content can serve as an important supplement to professional medical information, effectively responding to emotional demands such as actual care concerns and psychological adjustment that are often missing in clinical science videos. Therefore, even if the rating of patient generated content is low from the perspective of medical information professionalism, it should not be simply denied or abandoned. [ 31 ] We suggest that platforms and health communication entities explore flexible recommendation mechanisms to ensure that users can access their emotional and social core values, while also guiding them to prioritize medical information produced by authoritative entities such as neonatologists when making clinical diagnosis and treatment decisions. [ 32 ] HIE Socioeconomic Disparities Although the incidence of HIE is relatively low in large hospitals with well-developed obstetrics and neonatology departments, and neonatology teams can intervene promptly once HIE is detected by implementing early interventions for affected newborns through medications, mild hypothermia therapy, and other approaches to achieve favorable prognoses, but due to socioeconomic disparities across China have led to severe consequences for many infants in impoverished regions. In these areas, most caregivers lack the ability and awareness to identify HIE in its early stages; additionally, the relatively high costs associated with neonatology care prevent many families from accessing timely HIE interventions for various reasons. [ 33 ] Regrettably, compared with residents in economically developed metropolitan areas and those with higher educational attainment, populations in rural regions and individuals with lower education levels have weaker information-processing capacities and are less capable of obtaining accurate health information. Due to multiple factors, this group often overlooks the early identification of HIE and is precisely the demographic most vulnerable to the condition’s impacts.[ 34 ] While this study eliminated the interference of recommendation algorithms on research outcomes by registering new accounts, in real-world scenarios, when users search for relevant keywords, platforms deliver content based on their prior browsing habits. If users are continuously exposed to low-quality yet engaging videos, platforms can secure substantial traffic and economic gains, but users will be denied access to high-quality health information. The recurrence of this vicious cycle perpetuates existing health disparities and poses a significant barrier to achieving equitable health outcomes.[ 35 ] Advantages and limitations This study is the first domestic systematic evaluation of the quality and reliability of HIE-related short videos on two mainstream platforms, Douyin and Bilibili, filling the research gap in this field. By selecting two platforms with significantly different user positioning and content attributes for the study, it has improved the applicability of the results in different social media scenarios. Meanwhile, the study avoided algorithmic and subjective biases by registering new accounts, clearing browsing traces, and setting strict inclusion and exclusion criteria. It ensured the scientificity and credibility of the evaluation results through the use of standardized scales (GQS and mDISCERN) and the mechanism of "independent evaluation by two researchers and arbitration by authoritative experts". In addition, it constructed a comprehensive research framework by conducting multi-dimensional analyses from perspectives such as video characteristics, creator sources, and content categories, combined with correlation analysis. However, the study also has certain limitations. First, it only included 100 videos from each of the two platforms, resulting in a relatively limited sample size. Moreover, the search keywords did not cover English abbreviations and other related expressions, which may lead to sample omissions. Second, the study did not include other mainstream short-video platforms or overseas platforms, resulting in a narrow platform coverage. Additionally, the cross-sectional design adopted cannot reflect the dynamic changes of HIE-related video content over time. Furthermore, due to Douyin’s non-disclosure of video view count data, the statistics of interaction indicators are incomplete. What’s more, the lack of research on user-side information reception and behavior transformation has led to a certain disconnect between the research conclusions and practical application scenarios. Conclusion A total of 200 videos were collected in this study for data extraction and analysis, with 100 videos each from the Douyin and Bilibili platforms. The results showed that videos related to HIE on Bilibili were of overall high quality and high information credibility; by contrast, the same type of videos on Douyin suffered from poor content quality and low credibility. In terms of video morphological characteristics, Bilibili was dominated by long-duration professional science popularization videos, while Douyin tended to focus on highly interactive lightweight medical content. Further analysis indicated that, from the perspective of content creators’ identities, videos uploaded by professional medical practitioners were significantly superior in quality and information credibility to those uploaded by patient groups; in terms of video content types, disease knowledge popularization and treatment guidance videos also had higher quality and credibility than videos sharing patients’ personal diagnosis and treatment experiences. Based on the above research conclusions, medical practitioners need to attach great importance to the control of the quality and credibility of medical information disseminated on public social media platforms and take the initiative to assume the responsibility of popularizing authoritative medical knowledge. At the same time, social media platforms should strengthen the review and supervision of medical content, establish and improve a verification mechanism for the authenticity of medical information, and ensure the accuracy of medical information on the platforms; medical content creators should also strive to improve the professional standards and information rigor of their works to more accurately meet the public’s demand for medical knowledge. Declarations Funding and competing interests This study was supported by the Scientific Research Foundation of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, under the grant titled "Exploring the Intervention Effect of Yangyuan Xingshen Tuina on Cranial MRI, NBNA Score and Cerebral Function in Neonates with Hypoxic-Ischemic Encephalopathy" (Grant No. 22ZL11). The author(s) declare no competing interests. Author Contribution Jintao Wei, Yeyu Li, and Jing Yang are joint first authors with equal contributions, involved in study design, data collection, analysis, and manuscript drafting. Lirong Guan, Xue Wang, Ying Yuan, and Yue Zhou supported literature review, data collation, and manuscript revision. Jingyuan Fu conceived the study, designed the framework, supervised the work, revised the manuscript, and ensured study integrity. All authors approved the final version. Acknowledgement We thank the Hospital of Chengdu University of Traditional Chinese Medicine for support and all individuals involved in the study. Data Availability Data supporting this study are from publicly available HIE-related videos on Douyin and Bilibili, including video source, duration, content category, and user engagement metrics (likes, comments, shares, saves). GQS and mDISCERN scales were used for quality assessment. Analyses were performed with IBM SPSS 27.0 and GraphPad Prism 10.4.2. 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Lee, K. N. et al. YouTube as a source of information and education on endometriosis[J]. Medicine 101 (38), e30639 (2022). Yu, X. et al. Impact of social support on body image during chemotherapy in patients with breast cancer: The chain mediating role of depression and self-efficacy[J]. Asia-Pacific J. Oncol. Nurs. 12 , 100664 (2025). Wang, M. et al. Functions, advantages and challenges facing private healthcare organisations in China’s healthcare system: a qualitative analysis through open-ended questionnaires[J]. BMJ open. 13 (6), e069381 (2023). Zuluaga-Arias, H. P. et al. Impact of risk communication on patient’s safety during the pandemic[J]. Therapeutic Adv. Drug Saf. 14 , 20420986231159752 (2023). Shi, Z. et al. A systematic review of noninflammatory cerebrospinal fluid biomarkers for clinical outcome in neonates with perinatal hypoxic brain injury that could be biologically significant[J]. J. Neurosci. Res. 100 (12), 2154–2173 (2022). Ye, R. et al. Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis[J]. Prev. Med. Rep. 39 , 102617 (2024). He, F. et al. Quality and reliability of pediatric pneumonia related short videos on mainstream platforms: cross-sectional study[J]. BMC Public. Health . 25 (1), 1896 (2025). Additional Declarations No competing interests reported. Supplementary Files datas.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 16 Mar, 2026 Editor invited by journal 29 Dec, 2025 Editor assigned by journal 26 Dec, 2025 Submission checks completed at journal 26 Dec, 2025 First submitted to journal 25 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yeyu","middleName":"","lastName":"Li","suffix":""},{"id":608481032,"identity":"9987b915-55f5-4bb0-81c2-2f95423a846c","order_by":2,"name":"Jing Yang","email":"","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Yang","suffix":""},{"id":608481036,"identity":"550870b8-8482-4b17-848e-252c3fe3728a","order_by":3,"name":"Lirong Guan","email":"","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lirong","middleName":"","lastName":"Guan","suffix":""},{"id":608481042,"identity":"8662278b-6a56-47c1-977e-7edc1631d084","order_by":4,"name":"Xue Wang","email":"","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Wang","suffix":""},{"id":608481045,"identity":"e8864d0b-360f-444d-b8ce-3fd0d21d0b69","order_by":5,"name":"Ying Yuan","email":"","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Yuan","suffix":""},{"id":608481048,"identity":"0bc618ac-3161-405d-b860-3a60177bf8db","order_by":6,"name":"Yue Zhou","email":"","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Zhou","suffix":""},{"id":608481051,"identity":"9c220c83-fc73-408e-8119-69695514530a","order_by":7,"name":"Jingyuan Fu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACfmb+B4f//Khh5mdvIFKLZHsP4wPenmPskj0HiNRicOYMswEPGzO/wY0EYm2ZkXtMQoKHTVpy5uONNxhqbKIJauGXyEuTMLCQMeaXTiu2YDiWlttA2JYEM4kEHrZkydk5ZhKMDYcJawF6wUziABtz/YabZ4jVcuaMsWEDGzOzwQ0eIrVItrclPmbsOcYs2QP0SwIxfuFnZj5wmAEclYc33vhQY0NYC4ojJRJIUQ7RQqqOUTAKRsEoGBkAACTMPZJlESxAAAAAAElFTkSuQmCC","orcid":"","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jingyuan","middleName":"","lastName":"Fu","suffix":""}],"badges":[],"createdAt":"2025-12-25 14:08:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8449515/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8449515/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105017913,"identity":"c113e3ed-f079-4807-86c7-f237e24658cf","added_by":"auto","created_at":"2026-03-20 01:22:24","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23806,"visible":true,"origin":"","legend":"\u003cp\u003eSearch strategy for short videos on HIE\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/9bcbb6f10494e6657e5fa6ed.jpg"},{"id":105035497,"identity":"653cd911-f995-4f6a-a8ee-20b5ea28f0bf","added_by":"auto","created_at":"2026-03-20 07:26:12","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37867,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of videos on HIE from different sources and with different contents on Bilibili and Douyin:\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/ef0ea0361a0e5d350fcba568.jpg"},{"id":105017909,"identity":"b65fdea2-bda4-4a3a-b5cf-d5df10ff1221","added_by":"auto","created_at":"2026-03-20 01:22:24","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39206,"visible":true,"origin":"","legend":"\u003cp\u003eGQS and mDISCERN scores of videos related to HIE on Bilibili and Douyin: ****P \u0026lt; 0.0001\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/e50f618e81356d14e1eb21da.jpg"},{"id":105035584,"identity":"dd4ea3fc-3df5-47a1-b4a7-c787ae889249","added_by":"auto","created_at":"2026-03-20 07:26:17","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":45575,"visible":true,"origin":"","legend":"\u003cp\u003eGQS and mDISCERN scores of videos on HIE from different content types on Bilibili and Douyin: (a) GQS of Bilibili videos from different content types, (b) mDISCERN scores of Bilibili videos from different content types, (c) GQS of Douyin videos from different content types, and (d) mDISCERN scores of Douyin videos from different content types. GQS: Global Quality Scale; mDISCERN: modified DISCERN. ns not significant, *P \u0026lt; 0.05, **P \u0026lt; 0.01, ***P \u0026lt; 0.001, ****P \u0026lt; 0.0001.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/63297adcc0abe380bd1d9c6f.jpg"},{"id":105035281,"identity":"a03e54b3-5008-4e90-98d7-e89372c0fca7","added_by":"auto","created_at":"2026-03-20 07:25:47","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":40408,"visible":true,"origin":"","legend":"\u003cp\u003eGQS and mDISCERN scores of videos on HIE from different sources on Bilibili and Douyin: (A) GQS of Bilibili videos from different sources, (B) mDISCERN scores of Bilibili videos from different sources, (C) GQS of Douyin videos from different sources, and (D) mDISCERN scores of Douyin videos from different sources. GQS: Global Quality Scale; mDISCERN: modified DISCERN. *P \u0026lt; 0.05, **P \u0026lt; 0.01, ***P \u0026lt; 0.001, ****P \u0026lt; 0.0001.\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/4ed94181d763ee8f81c465ee.jpg"},{"id":105036839,"identity":"e95eed4c-22eb-4e58-833d-739f088ad062","added_by":"auto","created_at":"2026-03-20 07:36:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":995225,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/03dd57ea-2ee7-485a-8b91-e2b4bfa768a7.pdf"},{"id":105017912,"identity":"a42d6caf-90a5-449f-a983-3b78dd63a2a8","added_by":"auto","created_at":"2026-03-20 01:22:24","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":29958,"visible":true,"origin":"","legend":"","description":"","filename":"datas.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8449515/v1/1cc7b362143427859255a45b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality and Reliability of Neonatal Hypoxic-Ischemic Encephalopathy Related Short Videos on Douyin and Bilibili: A Cross-Sectional Content Analysis in Mainland China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypoxic-ischemic encephalopathy (HIE) is a brain injury that occurs due to hypoxia and reduced cerebral blood flow, and consequently leads to mortality as well as long-term neurological sequelae.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Newborns with HIE exhibit significant acidosis, which reflects recent hypoxic-ischemic insult\u0026mdash;alongside clinical signs of neonatal encephalopathy, such as reduced consciousness or poor muscle tone. Survivors of HIE may go on to develop long-term disabilities, including cerebral palsy and cognitive impairment.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] In developed countries, the incidence rate of HIE is 2 to 3 cases per 1000 neonates; in developing countries, this rate reaches 26 cases per 1000 neonates. Of these asphyxiated neonates with HIE, approximately 10% to 15% die during the neonatal period, and an additional 25% to 30% develop long-term sequelae. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The most common cause of hypoxic injury is intrauterine asphyxia, which is triggered by circulatory disorders, such as placental artery clotting, placental abruption, or inflammation. These issues lead to perinatal depression, subsequently reducing oxygen-carbon dioxide exchange and causing severe lactic acidosis.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The only effective treatment for HIE is therapeutic hypothermia, which has reduced the mortality rate of HIE from 25% to 9% and the mortality rate among infants with severe disabilities from 20% to 16%. However, although there is a reduction in cerebral palsy, cognitive impairment remains a significant issue. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] HIE not only causes significant harm to the infants themselves but also imposes severe burdens on their families and society. Therefore, it is crucial to achieve early detection of HIE, reduce its incidence, and improve treatment outcomes.\u003c/p\u003e \u003cp\u003eSince rooming-in for mothers and infants was first implemented in maternity wards around 1947, rooming-in with newborns has now been widely accepted. Rooming-in helps create a caring hospital environment, where family members can establish emotional bonds with newborns earlier.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] However, it also poses challenges to medical staff. Enabling family members to achieve early identification of potential HIE in newborns is a crucial component in preventing the occurrence and progression of HIE and alleviating its adverse outcomes. Meanwhile, social media and short videos related to HIE are a promising patient education tool. Social media is increasingly used in public health education as it breaks down physical barriers that long blocked access to healthcare support and resources. The public and healthcare professionals can communicate about health issues via social media, which may improve health outcomes. Previous research shows health information dissemination can change individuals\u0026rsquo; health behaviors, greatly improving early disease diagnosis and prevention. However, some non-professionals, may use social media to communicate and share information, which may spread misinformation. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Numerous studies have shown that compared with other methods, videos are more effective in disseminating health information due to their engaging nature, visual appeal, and ability to explain complex concepts. In recent years, short videos have gained immense popularity and exerted an impact on people's lives. Among various topics on short video platforms, health-related topics have grown extensively; currently, short videos have become a powerful tool for providing health advice and influencing people's health beliefs and behaviors.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Within the Chinese mainland, Bilibili and Douyin hold a prominent position among social media platforms centered on video content. Bilibili, a video-sharing platform widely favored by young people in China, provides users with abundant video resources and boasts a daily active user base of 107\u0026nbsp;million. As the Chinese domestic version of TikTok, Douyin has over 750\u0026nbsp;million daily active users and ranks among the top-tier applications in China in terms of popularity. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] On these platforms, users can freely access a large number of health-related videos by searching for keywords such as \"HIE\". Meanwhile, users have multiple ways to engage with the content, including leaving comments, giving likes, and using other interactive functions. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] However, the potential inaccurate or false information contained within them is highly misleading. It may lead to the widespread spread of such misinformation, thereby exerting a negative impact on public health. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Although Douyin and Bilibili contain videos related to HIE, no research has yet been conducted to evaluate the quality of videos related to HIE on short-video sharing platforms in Chinese mainland. Therefore, the purpose of this study is to conduct a detailed analysis of the quality of HIE-related videos accessible on Douyin and Bilibili.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy and Data Collection Methods\u003c/h2\u003e \u003cp\u003eThe search was conducted on Bilibili and Douyin from September 20 to September 30, 2025. To avoid bias caused by personalized recommendations, a new account was registered on both platforms, and searches were performed using the keywords \"新生儿缺氧缺血性脑病\"\u0026ldquo;新生儿缺血缺氧脑病\u0026rdquo; (HIE in Chinese). No other filtering criteria were applied to restrict the search. These videos were organized by the algorithms of Bilibili and Douyin. Prior research has demonstrated that most users primarily focus on the top content in online search results.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Therefore, only the top 100 relevant videos for each keyword on each platform were selected, and videos that met the following exclusion criteria were omitted: less than 1 week, duplication, advertisements, irrelevant content, pictures only, silent content and non-Chinese content. We collected the videos' source, duration, upload date, content, and the number of likes, comments, collections, shares, and views from users on September 30, 2025. Since Douyin does not publicly disclose video view counts, we did not include these metrics in our statistics.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSearch strategy for short videos on HIE\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVideo Classification Process\u003c/h3\u003e\n\u003cp\u003eBased on their source and content, the videos were each classified into four categories. Regarding video sources, the categories include neonatologists, other science communicators, patients. For video content, the categories are disease knowledge, disease treatment, case and experience sharing.\u003c/p\u003e\n\u003ch3\u003eQuality and Reliability Assessment of Video\u003c/h3\u003e\n\u003cp\u003eAll searches were conducted on public computers. Before conducting the searches, all settings and browsing history on the computers were cleared, and cookies were disabled during the search process to prevent any impact on the data. To assess the quality and reliability of video content, two widely used standardized scales, the GQS and mDISCERN, were utilized. The Global Quality Scale (GQS) is a five-point Likert scale that subjectively assesses videos\u0026rsquo; overall quality, structure, and informational completeness, and is frequently employed to measure the synergy between information delivery and platform usability.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The modified DISCERN (mDISCERN) tool, which is designed to evaluate the credibility of online health information, utilizes five equally weighted questions to establish a structured reliability framework. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Typically, the GQS and mDISCERN scales were used to assess the quality of the short videos in this study, with scoring ranging from 1 (poor) to 5 (excellent). [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Two researchers (JW, JY) independently completed the review and evaluation of all the aforementioned videos in this study. If there were inconsistencies in their evaluation results, they were rejudged and rescored by an authoritative neonatologist (YL).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical variables were summarized as frequencies and percentages. Non-normally distributed data were described using the median and range, or interquartile range (IQR, Q1-Q3). For comparisons between two groups, the Mann\u0026ndash;Whitney U test or Student\u0026rsquo;s t-test was used. For comparisons among three or more groups, one-way analysis of variance (ANOVA) or the Kruskal\u0026ndash;Wallis test was applied.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Spearman correlation analysis was used to explore correlations among all quantitative variables. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. IBM SPSS Statistics (Version 27.0, Windows) was used for statistical analyses, and GraphPad Prism (Version 10.4.2, Windows) was utilized for data visualization.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eClinical data, human specimens, and experimental animals were not involved in the present study. Instead, all data were sourced from publicly available videos on Douyin and Bilibili, thus ensuring no violations of personal privacy. Given the absence of any user interaction in this study, ethical review was not required.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eVideo characteristics\u003c/h2\u003e \u003cp\u003eThe present study incorporated a total of 200 videos, with an equal distribution of 100 videos sourced from each of the two platforms. As presented in Table\u0026nbsp;1, Douyin videos garnered statistically significant advantages in terms of engagement metrics, including likes, comments, saves, shares, and total view counts, when compared to Bilibili videos. Conversely, Bilibili videos exhibited a markedly longer average duration than their Douyin counterparts. Collectively, these findings indicate that Bilibili prioritizes long-form video content, while Douyin places greater emphasis on content that drives user interaction.\u003c/p\u003e \u003cp\u003eCharacteristics of the videos on Bilibili and Douyin.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDouyin, N\u0026thinsp;=\u0026thinsp;100\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBilibili, N\u0026thinsp;=\u0026thinsp;100\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58.0 (35.00, 130.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272.5 (123.00, 1262.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eShares\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119.5 (46.75, 591.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0 (0.00, 15.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLikes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e389.0 (133.00, 2195.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0 (1.00, 14.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127.0 (17.00, 623.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0 (0.00, 1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDays since published\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e387.0 (233.25, 860.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e882.0 (449.00, 1130.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVideo classifications\u003c/h3\u003e\n\u003cp\u003eWhen examining the characteristics of neonatal-related content across two major Chinese platforms, notable disparities emerge both in terms of upload sources and content distribution. From the perspective of video upload origins, the volume of videos posted by neonatologists (44%), other science communicators (30%), and patients (26%) on the Douyin platform is roughly equivalent, reflecting a relatively balanced contributor ecosystem. In stark contrast, Bilibili exhibits a lopsided distribution of content creators, where other science communicators dominate overwhelmingly, accounting for 73% of total uploads, while neonatologists (19%) and patients (8%) contribute a far smaller share of videos.In terms of content categories, Douyin\u0026rsquo;s content landscape is significantly more diversified: disease knowledge (47%), disease treatment (24%), and case and experience sharing (29%) all receive algorithmic promotion from the platform, indicating the platform\u0026rsquo;s strategy to cater to a broad range of information needs. On Bilibili, however, content is highly concentrated in the disease knowledge category, which constitutes 77% of all relevant videos and captures the bulk of platform traffic. By comparison, content related to disease treatment (11%) and case and experience sharing (12%) is not prioritized in the platform\u0026rsquo;s traffic allocation mechanism, highlighting Bilibili\u0026rsquo;s focus on academic and informational content over clinical guidance and personal experience sharing in the neonatal HIE field.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePercentage of videos on HIE from different sources and with different contents on Bilibili and Douyin:\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eVideo quality and reliability\u003c/h2\u003e \u003cp\u003eAcross the two core assessment metrics, GQS and mDISCERN, statistically significant disparities emerged between video content distributed on Douyin versus Bilibil. Quantitatively, Bilibili-hosted videos exhibited a median score of 4 for both GQS and mDISCERN\u0026mdash;metrics that collectively signal high content quality and strong informational reliability for this platform. Conversely, Douyin\u0026rsquo;s video content returned scores of 3 for both indices, a pattern that reflects comparatively diminished quality and reliability relative to the content available on Bilibili.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGQS and mDISCERN scores of videos related to HIE on Bilibili and Douyin: ****P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003cp\u003eWe compared GQS and mDISCERN scores across different content types and creator sources.For content types, GQS scores were no significant difference between the GQS scores of \"disease knowledge\" and \"disease treatment\". However, the GQS scores of both categories were significantly higher than that of \"case and experience sharing\". mDISCERN scores's trend was consistent with GQS: no significant difference existed between \"disease knowledge\" and \"disease treatment\", while both had significantly higher mDISCERN scores than \"case and experience sharing\", which is matching the above significance levels.For creator sources, Neonatologists had significantly higher GQS scores than other science communicators. Additionally, the GQS scores of neonatologists and other science communicators were both significantly higher than those of patients. Also, neonatologists obtained significantly higher mDISCERN scores than other science communicators. Moreover, the mDISCERN scores of neonatologists and other science communicators were all significantly higher than those of patients. No notable differences were observed among the remaining source groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGQS and mDISCERN scores of videos on HIE from different content types on Bilibili and Douyin: (a) GQS of Bilibili videos from different content types, (b) mDISCERN scores of Bilibili videos from different content types, (c) GQS of Douyin videos from different content types, and (d) mDISCERN scores of Douyin videos from different content types. GQS: Global Quality Scale; mDISCERN: modified DISCERN. ns not significant, *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, ****P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGQS and mDISCERN scores of videos on HIE from different sources on Bilibili and Douyin: (A) GQS of Bilibili videos from different sources, (B) mDISCERN scores of Bilibili videos from different sources, (C) GQS of Douyin videos from different sources, and (D) mDISCERN scores of Douyin videos from different sources. GQS: Global Quality Scale; mDISCERN: modified DISCERN. *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, ****P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between video quality and other parameters\u003c/h2\u003e \u003cp\u003eGiven that the data deviated from a normal distribution, Spearman\u0026rsquo;s rank correlation analysis was utilized to explore the associations among diverse video variables.\u003c/p\u003e \u003cp\u003eOn the Bilibili platform, multiple significant positive correlations emerged: GQS scores were strongly positively correlated with video duration (r\u0026thinsp;=\u0026thinsp;0.604, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), shares (r\u0026thinsp;=\u0026thinsp;0.440, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), likes (r\u0026thinsp;=\u0026thinsp;0.240, P\u0026thinsp;=\u0026thinsp;0.016), and days since publication (r\u0026thinsp;=\u0026thinsp;0.200, P\u0026thinsp;=\u0026thinsp;0.046). Correspondingly, mDISCERN scores exhibited significant positive correlations with video duration (r\u0026thinsp;=\u0026thinsp;0.556, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and shares (r\u0026thinsp;=\u0026thinsp;0.346, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while no meaningful associations were detected between mDISCERN scores and likes, comments, or days since publication (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eFor the Douyin platform, both GQS and mDISCERN scores showed significant positive correlations with video duration (GQS: r\u0026thinsp;=\u0026thinsp;0.294, P\u0026thinsp;=\u0026thinsp;0.003; mDISCERN: r\u0026thinsp;=\u0026thinsp;0.286, P\u0026thinsp;=\u0026thinsp;0.004). Conversely, GQS scores were significantly negatively correlated with comment counts (r = -0.226, P\u0026thinsp;=\u0026thinsp;0.024) and days since publication (r = -0.253, P\u0026thinsp;=\u0026thinsp;0.011); mDISCERN scores similarly displayed significant negative correlations with comments (r = -0.213, P\u0026thinsp;=\u0026thinsp;0.033) and days since publication (r = -0.208, P\u0026thinsp;=\u0026thinsp;0.038). No significant correlations were observed between GQS/mDISCERN scores and shares or likes on Douyin (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eSpearman correlation analysis between video variables and the GQS and mDISCERN scores. *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBilibili (r, P-value)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDouyin (r, P-value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGQS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emDISCERN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGQS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003emDISCERN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.604**, \u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.556**, \u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.294**, 0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.286**, 0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eShares\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.440**, \u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.346**, \u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071, 0.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.090, 0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLikes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.240*, 0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.092, 0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.154, 0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.136, 0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.031, 0.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.002, 0.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.226*, 0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.213*, 0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDays since published\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.200*, 0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.181, 0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.253*, 0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.208*, 0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSocial Media and Public Health Trends\u003c/h2\u003e \u003cp\u003eIn the field of public health education, the application of social media has achieved a leapfrog expansion in recent years, and this development trend is still continuing to strengthen. At its root, the widespread popularity of social media platforms is the core driving force, and such platforms are now deeply embedded in the links of health information dissemination and health science education, becoming an indispensable key medium.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] In this context, health institutions and professional practitioners at all levels have arranged social platforms such as Douyin and Bilibili to carry out targeted science popularization and content push of health knowledge for diverse audiences.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] However, it should be pointed out that due to the rapid iteration of social media technology and ecology, the timeliness of previous research conclusions in this field has been limited, and their conclusions may have undergone corresponding changes at this stage.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDual-Platform HIE Video Quality\u003c/h2\u003e \u003cp\u003eBased on a cross-sectional analysis, this study conducted a systematic evaluation of HIE-related science popularization videos on two major platforms, Douyin and Bilibili. The results revealed statistically significant differences in content quality and information reliability between the two platforms, indicating that the overall professionalism and credibility of HIE science popularization content on Douyin were inferior to those on Bilibili. To date, little or no longitudinal follow-up studies have focused on the quality of HIE videos on Douyin. However, a cross-comparison between the data of this study and earlier research on similar health science popularization videos suggests that the overall quality of specialized disease science content on short-video platforms has not achieved substantial improvement with the evolution of platform ecosystems.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo explore the core causes of the suboptimal quality of HIE videos on Douyin, two key factors were identified. First, content creators on the platform are evenly distributed across groups, and non-professional creators inherently lack sufficient medical knowledge reserves.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Second, this issue stems from the media characteristics of Douyin\u0026rsquo;s content: HIE videos on the platform have a significantly shorter average duration and mostly focus on sharing personal diagnosis and treatment experiences, lacking systematic validation from a professional perspective.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Notably, the quality and reliability of HIE videos on Douyin were only positively correlated with video duration, but showed no significant association with interaction metrics such as share volume and like count. Furthermore, their quality scores were negatively correlated with comment count and publication days. This finding reveals that under the platform\u0026rsquo;s entertainment-oriented ecosystem, low-professionalism HIE science content can gain traffic attention through high interactivity, while the dissemination efficiency of high-quality content is not fully realized. Compared with science popularization by professional neonatologists, personal experiences and emotional expressions from some patient families often resonate more with the general public.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] The above conclusions highlight the core contradiction between the professional quality of HIE science popularization videos and public engagement: high-quality medical science content struggles to translate into wide dissemination.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] This dilemma urgently needs to be addressed to improve the ability of neonatal families to identify HIE at an early stage.\u003c/p\u003e \u003cp\u003eIn stark contrast, HIE-related videos on Bilibili have a significantly longer average duration and maintain a high overall quality level. This advantage is attributed to two aspects. On one hand, it relies on the platform\u0026rsquo;s professional-oriented content creation model\u0026mdash;although neonatologists account for a small proportion of creators, most belong to professional science popularization groups, including practitioners from other departments (e.g., pediatricians, radiologists, basic medical scientists). Their content focuses on disease knowledge popularization, with a core emphasis on the accurate delivery of professional information such as HIE pathogenesis and early identification. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] On the other hand, video duration on Bilibili shows a strong positive correlation with both the GQS and mDISCERN score, suggesting that sufficient duration provides a critical guarantee for in-depth interpretation of complex HIE medical knowledge, systematic citation of authoritative literature, and the establishment of a complete science popularization logic.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] However, the high professional barriers of such content result in far lower dissemination and interaction volumes compared with Douyin. Despite their strong educational value, many videos receive little viewership and engagement due to their relatively tedious content. This is a topic requiring further in-depth exploration in future research: how to balance the scientific rigor and communicability of medical science popularization videos. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePatient HIE Content Value\u003c/h2\u003e \u003cp\u003eIt should be further pointed out that although this study confirmed through GQS and mDISCERN scales that the content quality and information reliability scores of HIE related videos uploaded by the patient population were significantly lower than those of neonatologists and professional science popularization creators, such content still has unique value and dissemination significance that cannot be ignored in the online health information dissemination ecosystem. From the perspective of content attributes, HIE related videos created by patients often focus on personal diagnosis and treatment experiences, disease treatment processes, and emotional counseling during the illness. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] They can provide psychological support and peer connections for families of newborns facing similar difficulties, and offer emotional comfort that professional medical science popularization content cannot cover. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] For families of newly diagnosed children with HIE, such experience sharing content can serve as an important supplement to professional medical information, effectively responding to emotional demands such as actual care concerns and psychological adjustment that are often missing in clinical science videos. Therefore, even if the rating of patient generated content is low from the perspective of medical information professionalism, it should not be simply denied or abandoned. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] We suggest that platforms and health communication entities explore flexible recommendation mechanisms to ensure that users can access their emotional and social core values, while also guiding them to prioritize medical information produced by authoritative entities such as neonatologists when making clinical diagnosis and treatment decisions. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eHIE Socioeconomic Disparities\u003c/h2\u003e \u003cp\u003eAlthough the incidence of HIE is relatively low in large hospitals with well-developed obstetrics and neonatology departments, and neonatology teams can intervene promptly once HIE is detected by implementing early interventions for affected newborns through medications, mild hypothermia therapy, and other approaches to achieve favorable prognoses, but due to socioeconomic disparities across China have led to severe consequences for many infants in impoverished regions. In these areas, most caregivers lack the ability and awareness to identify HIE in its early stages; additionally, the relatively high costs associated with neonatology care prevent many families from accessing timely HIE interventions for various reasons. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] Regrettably, compared with residents in economically developed metropolitan areas and those with higher educational attainment, populations in rural regions and individuals with lower education levels have weaker information-processing capacities and are less capable of obtaining accurate health information. Due to multiple factors, this group often overlooks the early identification of HIE and is precisely the demographic most vulnerable to the condition\u0026rsquo;s impacts.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWhile this study eliminated the interference of recommendation algorithms on research outcomes by registering new accounts, in real-world scenarios, when users search for relevant keywords, platforms deliver content based on their prior browsing habits. If users are continuously exposed to low-quality yet engaging videos, platforms can secure substantial traffic and economic gains, but users will be denied access to high-quality health information. The recurrence of this vicious cycle perpetuates existing health disparities and poses a significant barrier to achieving equitable health outcomes.[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAdvantages and limitations\u003c/h2\u003e \u003cp\u003eThis study is the first domestic systematic evaluation of the quality and reliability of HIE-related short videos on two mainstream platforms, Douyin and Bilibili, filling the research gap in this field. By selecting two platforms with significantly different user positioning and content attributes for the study, it has improved the applicability of the results in different social media scenarios. Meanwhile, the study avoided algorithmic and subjective biases by registering new accounts, clearing browsing traces, and setting strict inclusion and exclusion criteria. It ensured the scientificity and credibility of the evaluation results through the use of standardized scales (GQS and mDISCERN) and the mechanism of \"independent evaluation by two researchers and arbitration by authoritative experts\". In addition, it constructed a comprehensive research framework by conducting multi-dimensional analyses from perspectives such as video characteristics, creator sources, and content categories, combined with correlation analysis.\u003c/p\u003e \u003cp\u003eHowever, the study also has certain limitations. First, it only included 100 videos from each of the two platforms, resulting in a relatively limited sample size. Moreover, the search keywords did not cover English abbreviations and other related expressions, which may lead to sample omissions. Second, the study did not include other mainstream short-video platforms or overseas platforms, resulting in a narrow platform coverage. Additionally, the cross-sectional design adopted cannot reflect the dynamic changes of HIE-related video content over time. Furthermore, due to Douyin\u0026rsquo;s non-disclosure of video view count data, the statistics of interaction indicators are incomplete. What\u0026rsquo;s more, the lack of research on user-side information reception and behavior transformation has led to a certain disconnect between the research conclusions and practical application scenarios.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA total of 200 videos were collected in this study for data extraction and analysis, with 100 videos each from the Douyin and Bilibili platforms. The results showed that videos related to HIE on Bilibili were of overall high quality and high information credibility; by contrast, the same type of videos on Douyin suffered from poor content quality and low credibility. In terms of video morphological characteristics, Bilibili was dominated by long-duration professional science popularization videos, while Douyin tended to focus on highly interactive lightweight medical content.\u003c/p\u003e \u003cp\u003eFurther analysis indicated that, from the perspective of content creators\u0026rsquo; identities, videos uploaded by professional medical practitioners were significantly superior in quality and information credibility to those uploaded by patient groups; in terms of video content types, disease knowledge popularization and treatment guidance videos also had higher quality and credibility than videos sharing patients\u0026rsquo; personal diagnosis and treatment experiences.\u003c/p\u003e \u003cp\u003eBased on the above research conclusions, medical practitioners need to attach great importance to the control of the quality and credibility of medical information disseminated on public social media platforms and take the initiative to assume the responsibility of popularizing authoritative medical knowledge. At the same time, social media platforms should strengthen the review and supervision of medical content, establish and improve a verification mechanism for the authenticity of medical information, and ensure the accuracy of medical information on the platforms; medical content creators should also strive to improve the professional standards and information rigor of their works to more accurately meet the public\u0026rsquo;s demand for medical knowledge.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eand competing interests\u003c/p\u003e \u003cp\u003eThis study was supported by the Scientific Research Foundation of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, under the grant titled \"Exploring the Intervention Effect of Yangyuan Xingshen Tuina on Cranial MRI, NBNA Score and Cerebral Function in Neonates with Hypoxic-Ischemic Encephalopathy\" (Grant No. 22ZL11). The author(s) declare no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJintao Wei, Yeyu Li, and Jing Yang are joint first authors with equal contributions, involved in study design, data collection, analysis, and manuscript drafting. Lirong Guan, Xue Wang, Ying Yuan, and Yue Zhou supported literature review, data collation, and manuscript revision. Jingyuan Fu conceived the study, designed the framework, supervised the work, revised the manuscript, and ensured study integrity. All authors approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank the Hospital of Chengdu University of Traditional Chinese Medicine for support and all individuals involved in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData supporting this study are from publicly available HIE-related videos on Douyin and Bilibili, including video source, duration, content category, and user engagement metrics (likes, comments, shares, saves). GQS and mDISCERN scales were used for quality assessment. Analyses were performed with IBM SPSS 27.0 and GraphPad Prism 10.4.2. Raw data are submitted with the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDumbuya, J. S. et al. The role of G-CSF neuroprotective effects in neonatal hypoxic-ischemic encephalopathy (HIE): current status[J]. \u003cem\u003eJ. 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A systematic review of noninflammatory cerebrospinal fluid biomarkers for clinical outcome in neonates with perinatal hypoxic brain injury that could be biologically significant[J]. \u003cem\u003eJ. Neurosci. Res.\u003c/em\u003e \u003cb\u003e100\u003c/b\u003e (12), 2154\u0026ndash;2173 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe, R. et al. Gap in protective behaviors between Han and minority ethnicities during COVID-19 pandemic in rural western China: A decomposition analysis[J]. \u003cem\u003ePrev. Med. Rep.\u003c/em\u003e \u003cb\u003e39\u003c/b\u003e, 102617 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe, F. et al. Quality and reliability of pediatric pneumonia related short videos on mainstream platforms: cross-sectional study[J]. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e25\u003c/b\u003e (1), 1896 (2025).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8449515/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8449515/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHypoxic-ischemic encephalopathy (HIE) poses severe threats to neonates, with long-term neurological sequelae. Social media like Douyin and Bilibili has become vital for HIE health education, but misinformation risks exist. However, no studies have evaluated HIE-related video quality on these mainland China platforms, highlighting an urgent research gap.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eFrom September 20\u0026ndash;30, 2025, 200 top HIE-related videos (100 each from Douyin and Bilibili) were collected via new accounts. Videos were classified by source and content, then assessed using GQS and mDISCERN scales. Statistical analyses included Mann\u0026ndash;Whitney U test, ANOVA, and Spearman correlation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBilibili videos had longer duration and higher GQS and mDISCERN scores than Douyin. Douyin showed higher user engagement. Neonatologists\u0026rsquo; videos and disease knowledge and treatment content scored significantly higher in quality and reliability than patient-shared content.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBilibili provides higher-quality, more reliable HIE information, while Douyin focuses on interactive lightweight content. Medical professionals, platforms, and creators must collaborate to enhance medical information quality, ensuring accurate HIE knowledge dissemination for public health benefit.\u003c/p\u003e","manuscriptTitle":"Quality and Reliability of Neonatal Hypoxic-Ischemic Encephalopathy Related Short Videos on Douyin and Bilibili: A Cross-Sectional Content Analysis in Mainland China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-20 01:22:19","doi":"10.21203/rs.3.rs-8449515/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-16T11:24:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T15:21:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-26T07:48:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-26T07:47:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-25T13:52:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"99ce1f6b-67c0-4728-96f9-ce99cb57f710","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":64749831,"name":"Health sciences/Health care"},{"id":64749832,"name":"Health sciences/Medical research"},{"id":64749833,"name":"Health sciences/Neurology"}],"tags":[],"updatedAt":"2026-03-20T01:22:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 01:22:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8449515","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8449515","identity":"rs-8449515","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}