TikTok (Mis)information: An Assessment of the Understandability and Accuracy of Educational Social Media Content about Contraception

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Coleman, Maetal E. Haas-Kogan, Andrea Pelletier, Rachel E. Stoddard, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4892283/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Nov, 2024 Read the published version in Contraception and Reproductive Medicine → Version 1 posted 16 You are reading this latest preprint version Abstract Background Contraception knowledge and attitudes are largely formed from conversations within one’s social network. More recently, this network has expanded to include social media. As the most used social media platform, we aimed to assess popular contraception videos on TikTok for content understandability and accuracy. Methods This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability and actionability using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) instrument and for currency, relevance, authority, accuracy, and purpose (CRAAP) using modified instrument within the health information education literature. Results The 174 videos with educational content scored as understandable but not actionable in PEMAT-A/V assessment, with videos created by healthcare providers (HCPs) scoring higher than those by non-HCPs in six of eleven domains of understandability. Videos overall scored well in relevance and purpose within the CRAAP assessment. Videos created by HCP’s (n = 99) scored higher than those by non-HCPs (n = 75) in relevance (p < 0.001), authority (p < 0.001), accuracy (p < 0.001), and purpose (p < 0.001). Regarding video engagement, of all video views, 79.2% were of HCP-created videos and 20.8% were of non-HCP videos. Discussion Much of the contraceptive educational messaging on TikTok is understandable, relevant, and accurate, though these metrics differ between videos created by HCPs as compared to other creators. The videos created by HCP also had greater metrics of engagement. Given this, we encourage HCPs to use social media to better inform its users. Contraception social media health education TikTok birth control misinformation accuracy relevance PEMAT Background Patients rely on social networks for contraception decision making [ 1 ], networks that are now largely comprised of people who post on social media [ 2 ]. TikTok is the world’s fastest growing social media platform and users ages 18–24 are its largest demographic [ 3 , 4 ]. A prior content analysis study [ 5 ] of the 700 most viewed contraception TikTok videos categorized 36% of the videos as educational, defined as informing or teaching about a birth control method. Close to half of the educational videos (49.6%) were created by healthcare providers (HCPs) and these videos had much higher levels of user engagement (views, shares, likes, comments). The other half of educational content videos were created by non-HCPs that informed, most commonly, by the personal experience as current or former birth control users rather than by professional expertise. A recent report suggests a rise of contraceptive misinformation on social media, often urging users to switch to less effective contraception [ 6 ]. Younger people, the same demographic who most use TikTok, report lower levels of contraceptive use [ 7 ]. The potential for influential misinformation on social media is particularly alarming when reproductive options, particularly abortion, are limited through restrictive state laws. To gauge the degree of misinformation on TikTok, we performed a secondary analysis of the TikTok content analysis study by Stoddard et al. (2024) to evaluate the understandability, actionability, and scientific accuracy of those most-viewed videos containing contraception educational content [ 5 ]. These results represent the next step in understanding the potential cultural and personal influence of social media on people’s contraceptive decision-making. Methods In Stoddard et al. (2024), we performed a content analysis of the 700 most viewed contraception TikTok videos at the time of download in December 2021. We searched based on a previously published list of hashtags associated with contraception on social media for each of the six birth control methods: intrauterine devices (#iud), implant (#nexplanon), oral contraceptive pills (#birthcontrolpills), vaginal ring (#nuvaring), birth control patch (#birthcontrolpatch) and birth control injection (#depo). From this cohort, we coded 252 videos (36%) as educational, defined as “containing at least one take-home point or fact the creator is educating the viewer on” [ 5 ]. We limited our analysis to just these videos coded as educational as we recognized we could assess accuracy only those videos with factually derived, as opposed to emotionally derived, content (examples of the latter include jokes about birth control or political messaging). To measure video understandability and actionability, we used fourteen validated measures within the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) [ 8 ]. We rated each item on a binary scale of yes (1) or no (0). PEMAT scores were calculated as a percentage of the sum of the total points scored by the total points possible; higher percentages suggest greater understandability and actionability [ 8 ]. Two reviewers independently scored videos, and a third adjudicated discrepancies reaching substantial agreement for all items (Cohen’s Kappa > 0.7). To assess video reliability and accuracy, we used relevant questions from a previously modified version of the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test [ 9 ]. Initially developed to qualitatively assess the reliability of online educational resources [ 10 ], the CRAAP test has been adapted for quantitative assessment of health information scored with points within the domains of currency (0–5), relevance (0–4), authority (0–5), accuracy (0–7), and purpose (0–8) [ 9 ]. Compared to other instruments to evaluate medical information, the CRAAP test’s criteria focus on broad patient education rather than discrete, specific medical content, and thus is more suitable for social media content [ 10 ]. Two board-certified gynecologists (DB, NJ) coded the videos, with discrepancies adjudicated. We reported frequencies for each question within each domain for both PEMAT-A/V and CRAAP assessments. We performed a Chi-square test to compare groups for each question. We calculated means and standard deviations for summative domain scores. We used an independent samples t-test to evaluate differences in means between groups. We used Stata version 16.0 for analyses. This study was deemed exempt by Mass General Brigham IRB as non-human research. Results Of the 252 educational videos in the original dataset [ 5 ], 174 videos were included in this secondary analysis. Seventy-eight of the original videos were ineligible due to deletion (n = 46) or restriction (n = 16) of creators’ accounts since the original analysis, content being non-factual for assessment (n = 11), or nearly duplicate videos from the same creator (n = 5). Physicians, physician assistants, midwives, and nurses as HCPs created 57% (n = 99) of the eligible videos: these videos were engaged with to a much greater degree than those created by non-HCPs. The median number of views for all the videos was 604,450 with 9.8% of videos having over 5 million views. Of the 17 videos having over 5 million views, 15 (88.2%) were HCP-created and 2 (11.8%) were non-HCP created videos (p = 0.008). Of all views, 79.2% were of HCP-created videos and 20.8% were of non-HCP videos. The median number of likes was 58,100 with 60.5% coming from HCP-created videos and 39.5% from non-HCP videos. The median number of shares was 915 with 55.4% from HCP-created videos and 44.6% from non-HCP videos. The weighted mean score of all educational videos on PEMAT-A/V criteria for understandability was 74.7% (SD ± 17.4%, range 28.6–100) and for actionability was 37.7% (SD ± 40.7%, range 0-100%) of the total possible points, with established thresholds set at “understandable” and “actionable” if scored at 70% or higher [ 8 ]. Specific domains of understandability and actionability are presented for all videos overall and when comparing HCP with non-HCPs. While educational videos created by HCPs were significantly better in multiple domains of understandability and actionability but did not differ significantly in the PEMAT-A/V summative scores (Table 1 ). Table 1 Patient Education Materials Assessment Tool for Audiovisual Materials differences in mean scores by TikTok video creator type, N = 174 Overall HCP Non-HCP P-value Domains of Understandability, n(%)* Purpose is completely evident No 91 (52.3) 39 (39.4) 52 (69.3) Yes 83 (47.7) 60 (60.6) 23 (30.7) < 0.001 Uses common, everyday language No 48 (27.8) 42 (42.9) 6 (8.0) Yes 125 (72.3) 56 (57.1) 69 (92.0) < 0.001 Medical terms used only to familiarize audience with the term and are defined No 34 (19.7) 26 (26.5) 8 (10.7) Yes 139 (80.4) 72 (73.5) 67 (89.3) 0.009 Uses active voice No 8 (4.6) 5 (5.1) 3 (4.0) Yes 165 (95.4) 93 (94.9) 72 (96.0) 1.000 Breaks information into short sections No 2 (50.0) 0 (0.0) 2 (100.0) Yes 2 (50.0) 2 (100.0) 0 (0.0) 0.333 Sections have informative headers No 3 (75.0) 1 (50.0) 2 (100.0) Yes 1 (25.0) 1 (50.0) 0 (0.0) 1.000 Information presented in a logical sequence No 7 (4.1) 1 (1.0) 6 (8.0) Yes 166 (96.0) 97 (98.9) 69 (92.0) 0.044 Summary provided No 3 (75.0) 1 (50.0) 2 (100.0) Yes 1 (25.0) 1 (50.0) 0 (0.0) 1.000 Text is easy to read No 51 (32.9) 29 (33.0) 22 (32.8) Yes 104 (67.1) 59 (67.1) 45 (67.2) 0.988 Can hear the words clearly No 6 (5.6) 6 (11.1) 0 (0.0) Yes 101 (94.4) 48 (88.9) 53 (100.0) 0.027 Illustrations and photographs are clear and uncluttered No 73 (42.9) 27 (28.1) 46 (62.2) Yes 97 (57.1) 69 (71.9) 28 (37.8) < 0.001 Overall Understandability Mean (SD) Score, Percent of Total Possible Points 74.7 (17.4) 75.1 (18.7) 74.2 (15.7) 0.762 Domains of Actionability, n(%)* Clearly defines at least one action the user can take No 97 (55.8) 55 (55.6) 42 (56.0) Yes 77 (44.3) 44 (44.4) 33 (44.0) 0.953 Addresses the user directly when describing actions No 98 (56.3) 58 (58.6) 40 (53.3) Yes 76 (43.7) 41 (41.1) 35 (46.7) 0.489 Breaks down any action into manageable, explicit steps No 130 (74.7) 68 (68.7) 62 (82.7) Yes 44 (25.3) 31 (31.1) 13 (17.3) 0.036 Overall Actionability Mean (SD) Score, Percent of Total Possible Points 37.7 (40.7) 36.0 (38.3) 39.1 (42.6) 0.634 *Not all videos could be evaluated within each question of each domain, leading some videos to be scored as “not applicable.” Hence, some questions have small numbers reported. HCP = Healthcare professional SD = Standard deviation On the CRAAP assessment, all videos scored well on domains of currency, no matter the creator type. Overall, videos scored well in domains of relevance, though 33% of non-HCP created videos had overgeneralized their content beyond the specific relevance of the video topic. As would be expected, videos created by HCP scored very differently on all three domains of authority since the video content represents their professional expertise. Overall, the majority of videos scored well on domains of accuracy, though 26.7% of non-HCP content contradicted or could not be corroborated by published evidence. Almost 99% of videos were clear in stating their intended purpose, though the purpose differed between groups, with 99% of HCP creating content stating facts compared to non-HCP who presented a mix of facts (48.7%), opinion (43.2%), and propaganda (8.1%). HCP-created content demonstrated significantly greater summative scores for relevance, authority, accuracy, and purpose than non-HCP-created content (all p < 0.001) (Table 2 .) Table 2 Currency, relevance, authority, accuracy and purpose domains and differences in mean scores for contraception TikTok videos by creator type, N = 174 Overall HCP Non-HCP P-value Domains of Currency, n(%) Date created* > 5 years 0 (0) 0 (0) 0 (0) 1–5 years 61 (35.3) 40 (40.4) 21 (28.4) < 1 year 112 (64.7) 59 (59.6) 53 (71.6) 0.101 Information out of date Yes 8 (4.8) 1 (1.0) 7 (10.1) No 160 (95.2) 98 (99.0) 62 (89.9) 0.009 Embedded links still accessible? Yes 27 (15.7) 13 (13.3) 14 (18.9) No 8 (4.7) 3 (3.1) 5 (6.8) None listed 137 (79.7) 82 (83.7) 55 (74.3) 0.267 Overall Currency Mean (SD) Score, possible range 0–5 2.91 (0.95) 2.88 (0.84) 2.96 (1.10) 0.580 Domains of Relevance, n (%) Information answers central question Yes 159 (92.4) 99 (100.0) 60 (82.2) No 13 (7.6) 0 (0.0) 13 (17.8) < 0.001 Information identifies intended audience Yes 171 (100.0) 98 (100.0) 73 (100.0) No 0 (0) 0 (0) 0 (0) n/a Information appropriate for needs of intended audience Yes 159 (94.1) 97 (100.0) 62 (86.1) No 10 (5.9) 0 (0.0) 10 (13.9) < 0.001 Information avoids overgeneralization Yes 144 (82.8) 94 (95.0) 50 (66.7) No 30 (17.2) 5 (5.1) 25 (33.3) < 0.001 Overall Relevance Mean (SD) Score, possible range 0–4 3.64 (0.85) 3.92 (0.37) 3.27 (1.12) < 0.001 Domains of Authority, n(%) Identity of author/source Unclear 29 (17.5) 3 (3.0) 26 (38.8) Medication user/patient 40 (24.1) 1 (1.0) 39 (58.2) Expert in field 97 (58.4) 95 (96.0) 2 (3.0) < 0.001 Author’s credentials Unclear 32 (18.8) 3 (3.0) 29 (40.9) Lived experience 41 (24.1) 1 (1.0) 40 (56.3) Licensed medical professional 97 (57.1) 95 (96.0) 2 (2.8) < 0.001 Author qualified to discuss topic Yes 133 (94.3) 95 (100.0) 38 (82.6) No 8 (5.7) 0 (0.0) 8 (17.4) < 0.001 Overall Authority Mean (SD) Score , possible range 0–5 3.46 (1.96) 4.82 (0.88) 1.67 (1.48) < 0.001 Domains of Accuracy, n{%) Derivation of information Unclear 25 (14.8) 1 (1.0) 24 (33.8) Individual lived experience 41 (24.3) 2 (2.0) 39 (54.9) Professional experience 80 (47.3) 79 (80.6) 1 (1.4) Evidence-based review 23 (13.6) 16 (16.3) 7 (9.9) < 0.001 Information supported by evidence? Yes 153 (87.9) 98 (99.0) 55 (73.3) No 21 (12.1) 1 (1.0) 20 (26.7) < 0.001 What kind of evidence supports the claim? None 17 (10.0) 0 (0.0) 17 (23.6) Individual lived experience 8 (4.7) 0 (0.0) 8 (11.1) Expert/consensus opinion 8 (4.7) 4 (4.1) 4 (5.6) Published evidence-based guidelines 137 (80.6) 94 (95.9) 43 (59.7) < 0.001 Overall Accuracy Mean (SD) Score , possible range 0–7 4.93 (1.93) 6.02 (0.76) 3.49 (2.06) < 0.001 Domains of Purpose, n(%) Purpose of information Advertising 5 (2.9) 3 (3.0) 2 (2.7) Persuading/entertainment 12 (7.0) 2 (2.0) 10 (13.7) Informing 125 (72.7) 72 (72.7) 53 (72.6) Teaching 30 (17.4) 22 (22.2) 8 (11.0) 0.008 Intentions/purpose clear? Yes 169 (98.8) 98 (99.0) 71 (98.6) No 2 (1.2) 1 (1.0) 1 (1.4) 1.000 Nature of information Propaganda 6 (3.5) 0 (0.0) 6 (8.1) Opinion 33 (19.1) 1 (1.0) 32 (43.2) Facts 134 (77.5) 98 (99.0) 36 (48.7) < 0.001 Point of view objective and impartial Yes 143 (84.1) 97 (99.0) 46 (63.9) No 27 (15.9) 1 (1.0) 26 (36.1) < 0.001 Political, ideological, cultural, religious biases Yes 6 (3.5) 1 (1.0) 5 (6.9) No 165 (96.5) 98 (99.0) 67 (93.1) 0.084 Overall Purpose Mean (SD) Score , possible range 0–8 6.49 (1.33) 7.09 (0.70) 5.71 (1.55) < 0.001 *Scored from the time of the initial download in December, 2021. HCP = Healthcare professional SD = Standard deviation Discussion Contraception content posted on TikTok for the purpose of teaching or informing was understandable, but not actionable, according to PEMAT-A/V thresholds when created by both HCPs and non-HCPs. Overall, videos demonstrated good currency, relevance, authority, accuracy, and purpose, though, as would be expected, HCP-created content had greater scores of relevance, authority, accuracy, and purpose. Given the cultural mores about reproduction and birth control, sometimes resulting in mis- or even deliberate dis-information, we specifically used the CRAAP instrument for assessment to address the nature, partially, and biases of the information provided in videos. It was reassuring to find the strong overall scores on the CRAAP assessment. It is not surprising that the videos created by HCPs provided more accurate, objective, and evidence-based information in comparison to content by non-HCP rooted more often in personal experience. Our study has several implications related to TikTok’s utility in disseminating reliable contraception educational content. Given the platform’s popularity [ 3 ] and users’ high level of contraception video engagement [ 5 , 11 ], TikTok has potential to strongly influence contraception decision-making, particularly among younger users. Our cohort contained about 56% of videos created by HCPs, but these videos were quite popular, making up close to 80% of all video views. Given this viewership coupled with greater accuracy, reliability and objectivity of those videos created by HCPs, we should consider using this platform more to reach and teach the public at large. In an age of long wait times for healthcare appointments and short appointment visit times due to overloaded clinic templates, medical professionals should consider public education through social media as part of their educational mission. Other studies of TikTok have demonstrated strong engagement with videos created by medical professionals for dermatologic conditions [ 3 ] and sex education [ 11 ]. Direct to consumer education and communication are common in modern healthcare with the rise of electronic patient chart messaging and direct to consumer medical advertising. Given the large consumption of social media, this platform should not be overlooked or underestimated as a means of more effectively imparting our expertise and informing the public at large. Strengths of this study include the high popularity of the videos with large engagement metrics and the use of two validated scoring metrics to assess both accessibility to users and the accuracy of information. This study was limited by the difficulties in adapting some of these validated questions to the short-form videos of TikTok. We attempted to minimize subjectivity of PEMAT and CRAAP assessment through the use of two coders and assessment of coder agreement. Furthermore, since this is a secondary analysis of prior data collected in 2021, it is possible that changes have occurred in the content posted on TikTok. A next step in investigation will be to collect a new snapshot of contraception content on TikTok today and assess for changes between now and 2021 regarding content themes and accuracy. Lastly, our analysis is strictly on the content available and, to a limited degree what content TikTok users find appealing, as assessed through degree of views, likes, and shares. However, this line of inquiry does not assess what information they retain or what type of specific messaging they find interesting or helpful for contraceptive decision-making. Conclusion In an era of more extreme abortion restrictions, contraceptive use as primary prevention for unintended pregnancy is particularly important. Contraception content on social media has the potential to inform, either positively or negatively, the contraceptive decision-making process. Our findings are overall reassuring, with the most viewed contraception videos on TikTok demonstrating understandable and accurate educational content. HCPs must be aware of the inaccurate content that their patients might be seeing and that may be informing their healthcare decisions. As informed reproductive health professionals, we should consider using this and other social media platforms ourselves to create and promote highly reliable contraception education to the public. Abbreviations PEMAT-A/V: Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) CRAAP: currency, relevance, authority, accuracy, and purpose HCP: Healthcare provider IUD: Intrauterine device Declarations Ethics approval and consent to participate: This study was deemed exempt by Mass General Brigham IRB as non-human research. Consent for publication : Not applicable Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare no competing interests Funding: Not applicable Authors' contributions: JKC contributed to study design and led data analysis and manuscript development; MEH-K contributed to data analysis and manuscript development; AP led data analysis and contributed to manuscript development ; RES led data collection and contributed to manuscript development; NRJ contributed to data analysis and manuscript development; JRB contributed to study design, data analysis and manuscript development; NYS contributed to study design and manuscript development; ASK contributed to study design and manuscript development; DB contributed to study design, data analysis and manuscript production. All authors approved the final version of the manuscript. Acknowledgements: Not applicable References Yee L, Simon M. The role of the social network in contraceptive decision-making among young, African American and Latina women. J Adolesc Health. 2010;47:374–80. 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Has the fall of Roe changed contraceptive access and use? New research from four US states offers critical insights. Health Affairs Scholar. 2024;2:qxae016. Shoemaker SJ, Wolf MS, Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96:395–403. Garcia M, Daugherty C, Ben Khallouq B, Maugans T. Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet. J Neurosur Pediatr. 2018;21:535–41. Blakeslee S. The CRAAP test. LOEX Quarterly 2004;21:6–7. Accessed March 24, 2024. https://commons.emich.edu/loexquarterly/vol31/iss3/4 Fowler LR, Schoen L, Smith HS, Morain SR. Sex education on TikTok: a content analysis of themes. Health Promot Pract. 2021;23:739–41. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Nov, 2024 Read the published version in Contraception and Reproductive Medicine → Version 1 posted Editorial decision: Revision requested 12 Sep, 2024 Reviews received at journal 11 Sep, 2024 Reviews received at journal 04 Sep, 2024 Reviews received at journal 02 Sep, 2024 Reviewers agreed at journal 25 Aug, 2024 Reviewers agreed at journal 25 Aug, 2024 Reviewers agreed at journal 23 Aug, 2024 Reviewers agreed at journal 22 Aug, 2024 Reviews received at journal 21 Aug, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviewers invited by journal 20 Aug, 2024 Editor assigned by journal 12 Aug, 2024 Submission checks completed at journal 12 Aug, 2024 First submitted to journal 10 Aug, 2024 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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Haas-Kogan","email":"","orcid":"","institution":"Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Maetal","middleName":"E.","lastName":"Haas-Kogan","suffix":""},{"id":350961658,"identity":"21baee26-e607-4118-b0dd-492495f1e0cc","order_by":2,"name":"Andrea Pelletier","email":"","orcid":"","institution":"Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Pelletier","suffix":""},{"id":350961659,"identity":"e16025f7-47ed-41a7-a45b-f71d617141ed","order_by":3,"name":"Rachel E. Stoddard","email":"","orcid":"","institution":"University of North Carolina","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"E.","lastName":"Stoddard","suffix":""},{"id":350961660,"identity":"735bd82c-c400-4c00-b231-69f70977faa9","order_by":4,"name":"Natasha R. Johnson","email":"","orcid":"","institution":"Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Natasha","middleName":"R.","lastName":"Johnson","suffix":""},{"id":350961661,"identity":"5324e6a6-9426-4060-89fd-0c5f755944ec","order_by":5,"name":"Julia R. Beatini","email":"","orcid":"","institution":"Thomas Jefferson University","correspondingAuthor":false,"prefix":"","firstName":"Julia","middleName":"R.","lastName":"Beatini","suffix":""},{"id":350961662,"identity":"a0962948-e1c8-4d55-996f-443324a31479","order_by":6,"name":"Nora Y. Sun","email":"","orcid":"","institution":"Harvard University","correspondingAuthor":false,"prefix":"","firstName":"Nora","middleName":"Y.","lastName":"Sun","suffix":""},{"id":350961663,"identity":"c503577e-50d6-433e-8129-be4f13ac24fa","order_by":7,"name":"Alex S. Keuroghlian","email":"","orcid":"","institution":"Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Alex","middleName":"S.","lastName":"Keuroghlian","suffix":""},{"id":350961664,"identity":"fcd493f0-8a47-471c-ba8c-2bfef02d27be","order_by":8,"name":"Deborah Bartz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYDCCG2DSJoFBgoENKpTAwMBDSMsBhjTStRwmQQvf7eZnnz/8OZ9ncLuB7cHPPYflzdsTGB+8bcOtRfLOMeMZB3huFxvcOcBu2PPssOGcMw+YDefi0WJwI8GY4YDE7cRtNxLYJHgOpDHOkEhgk+bFqyX9M8MBg3NgLZJ/DqTZA7Ww/8avJQdoS8IBsBZpngM2iSBbmPFpkbxzppjhzIHkYvsbiW3SMgdskmfwPGyWnHMOtxa+2+2bGSr+2OVJzkg+JvnmgITtDPbkgx/elOHWggQYG9AZo2AUjIJRMArIBQC2Z1oSXfWNOQAAAABJRU5ErkJggg==","orcid":"","institution":"Harvard Medical School","correspondingAuthor":true,"prefix":"","firstName":"Deborah","middleName":"","lastName":"Bartz","suffix":""}],"badges":[],"createdAt":"2024-08-10 15:14:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4892283/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4892283/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40834-024-00324-5","type":"published","date":"2024-11-26T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70382517,"identity":"177d9d68-8b3f-463a-9532-1121b344ca62","added_by":"auto","created_at":"2024-12-02 16:27:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":842450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4892283/v1/25ea2c17-8196-4c52-a495-25b61be79d4b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"TikTok (Mis)information: An Assessment of the Understandability and Accuracy of Educational Social Media Content about Contraception","fulltext":[{"header":"Background","content":"\u003cp\u003ePatients rely on social networks for contraception decision making [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], networks that are now largely comprised of people who post on social media [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. TikTok is the world\u0026rsquo;s fastest growing social media platform and users ages 18\u0026ndash;24 are its largest demographic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A prior content analysis study [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] of the 700 most viewed contraception TikTok videos categorized 36% of the videos as educational, defined as informing or teaching about a birth control method. Close to half of the educational videos (49.6%) were created by healthcare providers (HCPs) and these videos had much higher levels of user engagement (views, shares, likes, comments). The other half of educational content videos were created by non-HCPs that informed, most commonly, by the personal experience as current or former birth control users rather than by professional expertise. A recent report suggests a rise of contraceptive misinformation on social media, often urging users to switch to less effective contraception [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Younger people, the same demographic who most use TikTok, report lower levels of contraceptive use [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The potential for influential misinformation on social media is particularly alarming when reproductive options, particularly abortion, are limited through restrictive state laws. To gauge the degree of misinformation on TikTok, we performed a secondary analysis of the TikTok content analysis study by Stoddard et al. (2024) to evaluate the understandability, actionability, and scientific accuracy of those most-viewed videos containing contraception educational content [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These results represent the next step in understanding the potential cultural and personal influence of social media on people\u0026rsquo;s contraceptive decision-making.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn Stoddard et al. (2024), we performed a content analysis of the 700 most viewed contraception TikTok videos at the time of download in December 2021. We searched based on a previously published list of hashtags associated with contraception on social media for each of the six birth control methods: intrauterine devices (#iud), implant (#nexplanon), oral contraceptive pills (#birthcontrolpills), vaginal ring (#nuvaring), birth control patch (#birthcontrolpatch) and birth control injection (#depo). From this cohort, we coded 252 videos (36%) as educational, defined as \u0026ldquo;containing at least one take-home point or fact the creator is educating the viewer on\u0026rdquo; [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. We limited our analysis to just these videos coded as educational as we recognized we could assess accuracy only those videos with factually derived, as opposed to emotionally derived, content (examples of the latter include jokes about birth control or political messaging).\u003c/p\u003e \u003cp\u003eTo measure video understandability and actionability, we used fourteen validated measures within the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. We rated each item on a binary scale of yes (1) or no (0). PEMAT scores were calculated as a percentage of the sum of the total points scored by the total points possible; higher percentages suggest greater understandability and actionability [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Two reviewers independently scored videos, and a third adjudicated discrepancies reaching substantial agreement for all items (Cohen\u0026rsquo;s Kappa\u0026thinsp;\u0026gt;\u0026thinsp;0.7).\u003c/p\u003e \u003cp\u003eTo assess video reliability and accuracy, we used relevant questions from a previously modified version of the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Initially developed to qualitatively assess the reliability of online educational resources [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the CRAAP test has been adapted for quantitative assessment of health information scored with points within the domains of currency (0\u0026ndash;5), relevance (0\u0026ndash;4), authority (0\u0026ndash;5), accuracy (0\u0026ndash;7), and purpose (0\u0026ndash;8) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Compared to other instruments to evaluate medical information, the CRAAP test\u0026rsquo;s criteria focus on broad patient education rather than discrete, specific medical content, and thus is more suitable for social media content [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Two board-certified gynecologists (DB, NJ) coded the videos, with discrepancies adjudicated.\u003c/p\u003e \u003cp\u003eWe reported frequencies for each question within each domain for both PEMAT-A/V and CRAAP assessments. We performed a Chi-square test to compare groups for each question. We calculated means and standard deviations for summative domain scores. We used an independent samples t-test to evaluate differences in means between groups. We used Stata version 16.0 for analyses. This study was deemed exempt by Mass General Brigham IRB as non-human research.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 252 educational videos in the original dataset [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], 174 videos were included in this secondary analysis. Seventy-eight of the original videos were ineligible due to deletion (n\u0026thinsp;=\u0026thinsp;46) or restriction (n\u0026thinsp;=\u0026thinsp;16) of creators\u0026rsquo; accounts since the original analysis, content being non-factual for assessment (n\u0026thinsp;=\u0026thinsp;11), or nearly duplicate videos from the same creator (n\u0026thinsp;=\u0026thinsp;5). Physicians, physician assistants, midwives, and nurses as HCPs created 57% (n\u0026thinsp;=\u0026thinsp;99) of the eligible videos: these videos were engaged with to a much greater degree than those created by non-HCPs. The median number of views for all the videos was 604,450 with 9.8% of videos having over 5\u0026nbsp;million views. Of the 17 videos having over 5\u0026nbsp;million views, 15 (88.2%) were HCP-created and 2 (11.8%) were non-HCP created videos (p\u0026thinsp;=\u0026thinsp;0.008). Of all views, 79.2% were of HCP-created videos and 20.8% were of non-HCP videos. The median number of likes was 58,100 with 60.5% coming from HCP-created videos and 39.5% from non-HCP videos. The median number of shares was 915 with 55.4% from HCP-created videos and 44.6% from non-HCP videos.\u003c/p\u003e \u003cp\u003eThe weighted mean score of all educational videos on PEMAT-A/V criteria for understandability was 74.7% (SD\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;17.4%, range 28.6\u0026ndash;100) and for actionability was 37.7% (SD\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;40.7%, range 0-100%) of the total possible points, with established thresholds set at \u0026ldquo;understandable\u0026rdquo; and \u0026ldquo;actionable\u0026rdquo; if scored at 70% or higher [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Specific domains of understandability and actionability are presented for all videos overall and when comparing HCP with non-HCPs. While educational videos created by HCPs were significantly better in multiple domains of understandability and actionability but did not differ significantly in the PEMAT-A/V summative scores (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Education Materials Assessment Tool for Audiovisual Materials differences in mean scores by TikTok video creator type, N\u0026thinsp;=\u0026thinsp;174\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHCP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-HCP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDomains of Understandability, n(%)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePurpose is completely evident\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eUses common, everyday language\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMedical terms used only to familiarize audience with the term and are defined\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eUses active voice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eBreaks information into short sections\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eSections have informative headers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation presented in a logical sequence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166 (96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (98.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eSummary provided\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eText is easy to read\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCan hear the words clearly\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIllustrations and photographs are clear and uncluttered\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Understandability Mean (SD) Score, Percent of Total Possible Points\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.7 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.1 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.2 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains of Actionability, n(%)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eClearly defines at least one action the user can take\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAddresses the user directly when describing actions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eBreaks down any action into manageable, explicit steps\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (82.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Actionability Mean (SD) Score, Percent of Total Possible Points\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.7 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.0 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.1 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Not all videos could be evaluated within each question of each domain, leading some videos to be scored as \u0026ldquo;not applicable.\u0026rdquo; Hence, some questions have small numbers reported.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eHCP\u0026thinsp;=\u0026thinsp;Healthcare professional\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD\u0026thinsp;=\u0026thinsp;Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn the CRAAP assessment, all videos scored well on domains of currency, no matter the creator type. Overall, videos scored well in domains of relevance, though 33% of non-HCP created videos had overgeneralized their content beyond the specific relevance of the video topic. As would be expected, videos created by HCP scored very differently on all three domains of authority since the video content represents their professional expertise. Overall, the majority of videos scored well on domains of accuracy, though 26.7% of non-HCP content contradicted or could not be corroborated by published evidence. Almost 99% of videos were clear in stating their intended purpose, though the purpose differed between groups, with 99% of HCP creating content stating facts compared to non-HCP who presented a mix of facts (48.7%), opinion (43.2%), and propaganda (8.1%). HCP-created content demonstrated significantly greater summative scores for relevance, authority, accuracy, and purpose than non-HCP-created content (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCurrency, relevance, authority, accuracy and purpose domains and differences in mean scores for contraception TikTok videos by creator type, N\u0026thinsp;=\u0026thinsp;174\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHCP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-HCP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDomains of Currency, n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDate created*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (71.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation out of date\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (89.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEmbedded links still accessible?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone listed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (74.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Currency Mean (SD) Score, possible range 0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.91 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.88 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.96 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains of Relevance, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation answers central question\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159 (92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation identifies intended audience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation appropriate for needs of intended audience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation avoids overgeneralization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Relevance Mean (SD) Score, possible range 0\u0026ndash;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.64 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.92 (0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.27 (1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains of Authority, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIdentity of author/source\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication user/patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpert in field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAuthor\u0026rsquo;s credentials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLived experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLicensed medical professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAuthor qualified to discuss topic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (94.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Authority Mean (SD) Score\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003epossible range 0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.46 (1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.82 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67 (1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains of Accuracy, n{%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDerivation of information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual lived experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvidence-based review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eInformation supported by evidence?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153 (87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eWhat kind of evidence supports the claim?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual lived experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpert/consensus opinion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublished evidence-based guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (95.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Accuracy Mean (SD) Score\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003epossible range 0\u0026ndash;7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.93 (1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.02 (0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.49 (2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains of Purpose, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePurpose of information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvertising\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersuading/entertainment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInforming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (72.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIntentions/purpose clear?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNature of information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropaganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpinion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePoint of view objective and impartial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143 (84.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePolitical, ideological, cultural, religious biases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165 (96.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Purpose Mean (SD) Score\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003epossible range 0\u0026ndash;8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.49 (1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.09 (0.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.71 (1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Scored from the time of the initial download in December, 2021.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eHCP\u0026thinsp;=\u0026thinsp;Healthcare professional\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD\u0026thinsp;=\u0026thinsp;Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eContraception content posted on TikTok for the purpose of teaching or informing was understandable, but not actionable, according to PEMAT-A/V thresholds when created by both HCPs and non-HCPs. Overall, videos demonstrated good currency, relevance, authority, accuracy, and purpose, though, as would be expected, HCP-created content had greater scores of relevance, authority, accuracy, and purpose. Given the cultural mores about reproduction and birth control, sometimes resulting in mis- or even deliberate dis-information, we specifically used the CRAAP instrument for assessment to address the nature, partially, and biases of the information provided in videos. It was reassuring to find the strong overall scores on the CRAAP assessment. It is not surprising that the videos created by HCPs provided more accurate, objective, and evidence-based information in comparison to content by non-HCP rooted more often in personal experience.\u003c/p\u003e \u003cp\u003eOur study has several implications related to TikTok\u0026rsquo;s utility in disseminating reliable contraception educational content. Given the platform\u0026rsquo;s popularity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and users\u0026rsquo; high level of contraception video engagement [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], TikTok has potential to strongly influence contraception decision-making, particularly among younger users. Our cohort contained about 56% of videos created by HCPs, but these videos were quite popular, making up close to 80% of all video views. Given this viewership coupled with greater accuracy, reliability and objectivity of those videos created by HCPs, we should consider using this platform more to reach and teach the public at large. In an age of long wait times for healthcare appointments and short appointment visit times due to overloaded clinic templates, medical professionals should consider public education through social media as part of their educational mission. Other studies of TikTok have demonstrated strong engagement with videos created by medical professionals for dermatologic conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and sex education [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Direct to consumer education and communication are common in modern healthcare with the rise of electronic patient chart messaging and direct to consumer medical advertising. Given the large consumption of social media, this platform should not be overlooked or underestimated as a means of more effectively imparting our expertise and informing the public at large.\u003c/p\u003e \u003cp\u003eStrengths of this study include the high popularity of the videos with large engagement metrics and the use of two validated scoring metrics to assess both accessibility to users and the accuracy of information. This study was limited by the difficulties in adapting some of these validated questions to the short-form videos of TikTok. We attempted to minimize subjectivity of PEMAT and CRAAP assessment through the use of two coders and assessment of coder agreement. Furthermore, since this is a secondary analysis of prior data collected in 2021, it is possible that changes have occurred in the content posted on TikTok. A next step in investigation will be to collect a new snapshot of contraception content on TikTok today and assess for changes between now and 2021 regarding content themes and accuracy. Lastly, our analysis is strictly on the content available and, to a limited degree what content TikTok users find appealing, as assessed through degree of views, likes, and shares. However, this line of inquiry does not assess what information they retain or what type of specific messaging they find interesting or helpful for contraceptive decision-making.\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eIn an era of more extreme abortion restrictions, contraceptive use as primary prevention for unintended pregnancy is particularly important. Contraception content on social media has the potential to inform, either positively or negatively, the contraceptive decision-making process. Our findings are overall reassuring, with the most viewed contraception videos on TikTok demonstrating understandable and accurate educational content. HCPs must be aware of the inaccurate content that their patients might be seeing and that may be informing their healthcare decisions. As informed reproductive health professionals, we should consider using this and other social media platforms ourselves to create and promote highly reliable contraception education to the public.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePEMAT-A/V: Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) CRAAP: currency, relevance, authority, accuracy, and purpose\u003c/p\u003e\n\u003cp\u003eHCP: Healthcare provider\u003c/p\u003e\n\u003cp\u003eIUD: Intrauterine device\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This study was deemed exempt by Mass General Brigham IRB as non-human research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e JKC contributed to study design and led data analysis and manuscript development; MEH-K contributed to data analysis and manuscript development; AP led data analysis and contributed to manuscript development ; RES led data collection and contributed to manuscript development; NRJ contributed to data analysis and manuscript development; JRB contributed to study design, data analysis and manuscript development; NYS contributed to study design and manuscript development; ASK contributed to study design and manuscript development; DB contributed to study design, data analysis and manuscript production. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYee L, Simon M. The role of the social network in contraceptive decision-making among young, African American and Latina women. J Adolesc Health. 2010;47:374\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKofinas JD, Varrey A, Sapra KJ, Kanj RV, Chervenak FA, Asfaw T. Adjunctive social media for more effective contraceptive counseling: a randomized controlled trial. Obstet Gynecol. 2014;123:763\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVilla-Ruiz C, Kassamali B, Mazori DR, Min M, Cobos G, LaChance A. Overview of TikTok\u0026rsquo;s most viewed dermatologic content and assessment of its reliability. J Am Acad Dermatol. 2021;85:273\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCeci L. TikTok: distribution of global audiences 2024, by age and gender. Statista 2024. Accessed April 20, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.statista.com/statistics/1299771/tiktok-global-user-age-distribution/\u003c/span\u003e\u003cspan address=\"https://www.statista.com/statistics/1299771/tiktok-global-user-age-distribution/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoddard RE, Pelletier A, Sundquist EN, et al. Popular contraception videos on TikTok: An assessment of content topics. Contraception. 2024;129:110300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeber L, Malhi S. Women are getting off birth control amid misinformation explosion. \u003cem\u003eThe Washington Post\u003c/em\u003e 2024. Accessed April 17, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.washingtonpost.com/health/2024/03/21/stopping-birth-control-misinformation/\u003c/span\u003e\u003cspan address=\"https://www.washingtonpost.com/health/2024/03/21/stopping-birth-control-misinformation/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKavanaugh ML, Friedrich-Karnik A. Has the fall of Roe changed contraceptive access and use? New research from four US states offers critical insights. Health Affairs Scholar. 2024;2:qxae016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShoemaker SJ, Wolf MS, Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96:395\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia M, Daugherty C, Ben Khallouq B, Maugans T. Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet. J Neurosur Pediatr. 2018;21:535\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlakeslee S. The CRAAP test. \u003cem\u003eLOEX Quarterly\u003c/em\u003e 2004;21:6\u0026ndash;7. Accessed March 24, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://commons.emich.edu/loexquarterly/vol31/iss3/4\u003c/span\u003e\u003cspan address=\"https://commons.emich.edu/loexquarterly/vol31/iss3/4\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFowler LR, Schoen L, Smith HS, Morain SR. Sex education on TikTok: a content analysis of themes. Health Promot Pract. 2021;23:739\u0026ndash;41.\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":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"contraception-and-reproductive-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"carm","sideBox":"Learn more about [Contraception and Reproductive Medicine](http://contraceptionmedicine.biomedcentral.com)","snPcode":"40834","submissionUrl":"https://submission.nature.com/new-submission/40834/3","title":"Contraception and Reproductive Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Contraception, social media, health education, TikTok, birth control, misinformation, accuracy, relevance, PEMAT","lastPublishedDoi":"10.21203/rs.3.rs-4892283/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4892283/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eContraception knowledge and attitudes are largely formed from conversations within one\u0026rsquo;s social network. More recently, this network has expanded to include social media. As the most used social media platform, we aimed to assess popular contraception videos on TikTok for content understandability and accuracy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability and actionability using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) instrument and for currency, relevance, authority, accuracy, and purpose (CRAAP) using modified instrument within the health information education literature.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe 174 videos with educational content scored as understandable but not actionable in PEMAT-A/V assessment, with videos created by healthcare providers (HCPs) scoring higher than those by non-HCPs in six of eleven domains of understandability. Videos overall scored well in relevance and purpose within the CRAAP assessment. Videos created by HCP\u0026rsquo;s (n\u0026thinsp;=\u0026thinsp;99) scored higher than those by non-HCPs (n\u0026thinsp;=\u0026thinsp;75) in relevance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), authority (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), accuracy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and purpose (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding video engagement, of all video views, 79.2% were of HCP-created videos and 20.8% were of non-HCP videos.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eMuch of the contraceptive educational messaging on TikTok is understandable, relevant, and accurate, though these metrics differ between videos created by HCPs as compared to other creators. The videos created by HCP also had greater metrics of engagement. Given this, we encourage HCPs to use social media to better inform its users.\u003c/p\u003e","manuscriptTitle":"TikTok (Mis)information: An Assessment of the Understandability and Accuracy of Educational Social Media Content about Contraception","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-09 18:48:57","doi":"10.21203/rs.3.rs-4892283/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-12T11:53:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-11T21:59:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-05T02:00:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-02T12:45:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231221309354146783160489404287873635628","date":"2024-08-25T15:18:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179823092847151078906954485397444567927","date":"2024-08-25T14:13:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200974861044501472127905435746580513704","date":"2024-08-23T15:45:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77031329355210959562326918097523986181","date":"2024-08-22T12:43:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-21T18:55:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337864087130958948392786568136584303593","date":"2024-08-20T13:44:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199667217141662858701591318938703480343","date":"2024-08-20T13:01:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138402598539243837034196556085890471801","date":"2024-08-20T12:36:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-20T12:22:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-12T07:33:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-12T07:31:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Contraception and Reproductive Medicine","date":"2024-08-10T15:11:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"contraception-and-reproductive-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"carm","sideBox":"Learn more about [Contraception and Reproductive Medicine](http://contraceptionmedicine.biomedcentral.com)","snPcode":"40834","submissionUrl":"https://submission.nature.com/new-submission/40834/3","title":"Contraception and Reproductive Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"416f3efb-80cd-4af1-bf47-77553ab6914e","owner":[],"postedDate":"September 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T16:01:47+00:00","versionOfRecord":{"articleIdentity":"rs-4892283","link":"https://doi.org/10.1186/s40834-024-00324-5","journal":{"identity":"contraception-and-reproductive-medicine","isVorOnly":false,"title":"Contraception and Reproductive Medicine"},"publishedOn":"2024-11-26 15:57:27","publishedOnDateReadable":"November 26th, 2024"},"versionCreatedAt":"2024-09-09 18:48:57","video":"","vorDoi":"10.1186/s40834-024-00324-5","vorDoiUrl":"https://doi.org/10.1186/s40834-024-00324-5","workflowStages":[]},"version":"v1","identity":"rs-4892283","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4892283","identity":"rs-4892283","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}