Evaluating the reliability and quality of Acute cholecystitis educational contenton TikTok and Bilibili: A cross-sectionalcontent analysis

Evaluating the reliability and quality of Acute cholecystitis educational contenton TikTok and Bilibili: A cross-sectionalcontent analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the reliability and quality of Acute cholecystitis educational contenton TikTok and Bilibili: A cross-sectionalcontent analysis Hong-yan Ma, Tie-song Wu, Hao Song, Rong Bai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9276663/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: TikTok and Bilibili are rapidly becoming important channels for the public to obtain health information. This study aimed to evaluate the content, quality, and reliability of videos related to acute cholecystitis (AC) on the TikTok and Bilibili platforms. Methods: Using “acute cholecystitis” as the keyword, videos were retrieved and evaluated with the Global Quality Score (GQS) and modified DISCERN (mDISCERN) as well as content completeness score. The Mann–Whitney U test was used to compare differences between platforms, the Kruskal–Wallis test was applied to analyze differences among uploader groups, and Spearman rank correlation analysis was performed to explore correlations. Results: A total of 172 AC-related videos were included in this study. Among the videos, clinical manifestations (65.7%) and treatment (61.05%) were the most frequently covered topics, whereas prevention-related content appeared in only 18.6%. The overall median GQS score was 3.00 (IQR: 2.00-3.00), the median mDISCERN score was 3.00 (IQR: 2.00-3.00), and the median content completeness score was 2.00 (IQR: 2.00-4.00). Videos from specialist physicians and institutions scored significantly higher in quality, reliability, and content completeness than those from non-specialist physicians (*p* 0.05). Conclusions: The overall quality and reliability of AC-related videos on TikTok and Bilibili are suboptimal. In the future, supervision and regulation of AC-related content on these two platforms should be strengthened to promote the effective dissemination of high-quality health information. Acute cholecystitis Short-video platforms Health information quality Content analysis Information reliability Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Acute cholecystitis (AC) is an acute inflammatory condition of the gallbladder that typically presents with right upper abdominal pain, fever, and elevated white blood cell count, and is one of the most common causes of acute abdominal emergencies [ 1 – 2 ] . AC can significantly impair patients’ quality of life and may progress to severe complications such as gallbladder gangrene, perforation, abscess formation or systemic inflammatory responses, thereby increasing both clinical and economic burdens [ 3 ] . AC may also induce inflammatory activation, hypercoagulability or heightened stress responses, resulting in downstream complications including thrombosis, stroke or renal injury. Individuals with recurrent symptom episodes are at elevated risk of developing biliary colic, biliary obstruction or pancreatitis [ 4 – 6 ] . Access to accurate, timely, and reliable health information is therefore critical—not only for promoting prevention and early recognition, but also for guiding appropriate healthcare-seeking and informed decision-making. Short-video platforms have rapidly transformed how the public accesses medical information, offering visually engaging content and broad reach—particularly among younger audiences [ 7 – 9 ] . Platforms such as TikTok and Bilibili offer rapid dissemination, visually engaging formats, and strong interactivity, enabling large audiences, particularly younger users, to access abundant health-related information within a short period [ 10 – 11 ] . However, the low threshold for content creation and the lack of rigorous medical review contribute to substantial variability in information quality, including inaccurate or misleading content [ 12 ] . Previous studies have identified unverified or unreliable health information in videos addressing conditions such as idiopathic pulmonary fibrosis, COVID-19, helicobacter pylori, gallstone disease, and liver cancer [ 13 – 17 ] . Given the relatively high incidence of AC, its potential for serious complications, and the harmful consequences of delayed diagnosis, exposure to low-quality online video content may impede timely disease recognition and appropriate healthcare-seeking behavior. These concerns underscore the importance of systematically evaluating the quality and reliability of AC-related videos on these platforms.In this study, we assess the quality and reliability of AC-related videos on TikTok and Bilibili, comparing content across platforms and uploader types. Our findings are intended to highlight current gaps in digital health communication and offer evidence to guide improvements in content governance and patient education. Methods Data Retrieval Searches were conducted on TikTok and Bilibili on October 14, 2025, using the Chinese keyword “急性胆囊炎” (“acute cholecystitis”). To minimize the influence of personalized recommendation algorithms, browser history was cleared and newly registered accounts were used for the searches. In the initial screening phase, the top 100 videos and the top 100 video sranked under TikTok and Bilibili platform’s comprehensive sorting criteria were retrieved for further evaluation. Inclusion and Exclusion Criteria The inclusion criteria were: (1) videos related to acute cholecystitis (AC); and (2) videos presented in Chinese. The exclusion criteria were: (1) videos unrelated to AC; (2) advertisements or promotional content; (3) duplicate or re uploaded videos; (4) videos with poor audiovisual quality that impeded comprehension; and (5) videos uploaded within one week prior to data collection. A total of 172 videos met the inclusion criteria and were included in the final analysis, and the detailed screening process is presented in Fig. 1 . Data Extraction and Classification For each video, the following data were collected: platform source, video duration (seconds), number of likes, number of comments, number of favorites, number of shares, uploader type, and video content. Uploaders were categorized as Specialist physicians, non-specialist physicians, or institutions. Specialist physicians included hepatobiliary surgeons, general surgeons, and related specialists, whereas non-specialist physicians included traditional Chinese medicine physicians, radiologists, and emergency surgeons. Institutional uploaders comprised medical colleges and universities, educational organizations, and official accounts. Video content was classified into six categories: epidemiology, etiology, clinical manifestations, diagnosis, treatment, and prevention. Quality and Reliability Assessment The GQS quantifies online video quality using a five-tier grading system, with scores ranging from 1 (poor) to 5 (excellent) [ 18 ] . The mDISCERN instrument, originally developed for evaluating written health materials, has been adapted to assess the reliability of video content [ 19 – 21 ] . This modified tool employs a five-item questionnaire with a scoring scale of 1–5, where elevated scores correspond to enhanced content reliability. The detailed scoring criteria for these two instruments are presented in Tables 1 and 2 . The completeness of video content is scored based on whether it covers the key aspects of AC (such as epidemiology, etiology, clinical manifestations, diagnosis, treatment, and prevention). Each item of the video content score ranges from 0 to 2 points (0 point: not covered, 1 point: partially covered, 2 points: complete coverage), the total score of the collected video content completeness is the sum of the scores of the above five items. The above GQS, mDISCERN and Content Completeness Score [ 22 ] were independently completed by two evaluators with clinical backgrounds in hepatobiliary surgery or related specialties (including 1 hepatobiliary surgery clinician and 1 hepatobiliary surgery clinical pharmacist). In case of disagreement, the third professional in the relevant field (a hepatobiliary surgery clinical pharmacist) made the ruling. Table 1 The Global Quality Score (GQS) quality criteria. Item features Points Poor quality; poor flow of the videos; most information missing; not at all useful for patients 1 Generally poor quality; some information listed, but many important topics missing; of very limited use to patients 2 Moderate quality; suboptimal flow; some important adequately discussed, but other information poorly discussed; somewhat useful for patients 3 Good quality and generally good flow; most of the relevant information listed, but some topics not covered; useful for patients 4 Excellent quality and flow; very useful for patients 5 Table 2 The Modified DISCERN (mDISCERN) quality criteria. Reliability Score 1. Is the video clear, concise, and understandable? 2. Are valid sources cited? 3. Is the content presented balanced and unbiased? 4. Are additional sources of content listed for patient reference? 5. Are areas of uncertainty mentioned? Statistical Analysis Descriptive statistical methods were used to summarize the continuous variables. Data with normal distribution were expressed as mean ± standard deviation (SD), while data with non-normal distribution were expressed as median and interquartile range (IQR). Categorical variables were expressed as frequency and percentage. When comparing groups, variables with normal distribution were analyzed using the independent sample t-test, and variables with non-normal distribution were analyzed using the Mann–Whitney U test. Comparisons of three or more groups were performed using the Kruskal–Wallis H test, and when the differences were statistically significant, pairwise comparisons were further conducted using Dunn's test. Spearman rank correlation coefficient was used to evaluate the correlation between video quality scores (GQS and mDISCERN) and interaction indicators (likes, comments, shares, and favorites). A two-sided P value < 0.05 was considered statistically significant. All statistical analyses and graphical visualizations were performed using R software (version 4.3.2). Results General feature description of the video After applying the inclusion and exclusion criteria, 172 videos were included in the final analysis—81 (47.1%) from Bilibili and 91 (52.9%) from TikTok. Of these, 81 (47.1%) were from Bilibili and 91 (52.9%) from TikTok. Analysis of the overall video features showed that the median video length is 97.00s (IQR: 61.00-204.25). The median number of likes was 81.50 (IQR: 21.75–426.00), the median number of Collections is 35.50 (IQR: 10.00-171.50), the median number of comments is 9.50 (IQR: 1.00–35.00), and the median number of shares is 18.50 (IQR: 3.00-109.00), as shown in Table 3 . Table 3 General Characteristics, Quality, and Reliability of the Acute cholecystitis Videos. Variables Total (n = 172 ) General information Video length(s),M (Q1,Q3) 97.00 (61.00, 204.25) Likes,M (Q1,Q3) 81.50 (21.75, 426.00) Collections,M (Q1,Q3) 35.50 (10.00, 171.50) Comments,M (Q1,Q3) 9.50 (1.00, 35.00) Shares,M (Q1,Q3) 18.50 (3.00, 109.00) Video content epidemiology 9(5.23%) Etiology 54(31.4%) Clinical manifestation 113(65.7%) Diagnosis 61(35.47%) Treatment 105(61.05) Prevention 32(18.6%) Video quality GQS score,M (Q1,Q3) 3.00 (2.00, 3.00) mDISCERN score,M (Q1,Q3) 3.00 (2.00, 3.00) content completeness score, M (Q₁, Q₃) 2.00 (2.00, 4.00) Compared with Bilibili, videos on TikTok were shorter in duration ( p < 0.05) but received higher numbers of likes, comments, and shares ( p < 0.05). On TikTok, the median video length was 71.00 (IQR: 47.50–106.00), the median number of likes was 208.00 (IQR: 63.00-764.00), the median number of collections is 53.00 (IQR: 12.00-267.50), the median number of comments was 19.00 (IQR: 8.00-72.50), and the median number of shares was 35.00 (IQR: 11.00-173.00) (Table 4 ). Table 4 General Information, Quality, and Reliability Scores of Acute cholecystitis Videos on TikTok and Bilibili. Variables Bilibili (n = 81) TikTok (n = 91) P General information Video length(s),M (Q1,Q3) 223.00 (93.00, 620.00) 71.00 (47.50, 106.00) < .001 Likes,M (Q1,Q3) 22.00 (6.00, 101.00) 208.00 (63.00, 764.00) < .001 Collections,M (Q1,Q3) 29.00 (5.00, 143.00) 53.00 (12.00, 267.50) 0.077 Comments,M (Q1,Q3) 2.00 (0.00, 13.00) 19.00 (8.00, 72.50) < .001 Shares,M (Q1,Q3) 8.00 (2.00, 36.00) 35.00 (11.00, 173.00) < .001 Video content Epidemiology 6(7.14%) 3(3.30%) - Etiology 27(33.33%) 27(29.67%) - Clinical manifestation 50(61.73%) 63(69.23%) - Diagnosis 31(38.27%) 30(32.97%) - Treatment 43(53.09%) 62(68.13%) - Prevention 10(12.35%) 22(24.18%) - Video quality GQS score,M (Q1,Q3) 3.00 (2.00, 3.00) 3.00 (3.00, 3.00) 0.112 mDISCERN score,M (Q1,Q3) 3.00 (2.00, 3.00) 3.00 (2.00, 3.00) 0.968 content completeness score, M (Q₁, Q₃) 2.00 (1.00, 4.00) 3.00 (2.00, 4.00) 0.147 The median duration of videos uploaded by Specialist physicians was 84.00 (IQR: 53.00-121.00), with a median number of likes of 108.00 (IQR: 40.00-613.00), Collections is 38.00 (IQR: 10.00-179.00), comments of 13.00 (IQR: 2.00–55.00), and shares of 27.00 (IQR: 6.00-120.00). The baseline characteristics of videos uploaded by other uploader groups are presented in Table 5 . Table 5 Characteristics, Quality, and Reliability of Acute cholecystitis Videos by Different Uploaders on TikTok and Bilibili. Variables Non-specialist physicians (n = 21, 12.21%) Institutions (n = 26, 15.12% ) Specialist physicians (n = 125, 72.67% ) P Video length(s),M (Q1,Q3) 132.00 (72.00,348.00) 610.00 (274.25,1076.00) 84.00 (53.00,121.00) < .001 Likes,M (Q1,Q3) 17.00 (6.00,235.00) 23.00 (11.00,124.50) 108.00 (40.00,613.00) < .001 Collections,M (Q1,Q3) 23.00 (5.00,224.00) 40.50 (15.50,144.50) 38.00 (10.00,179.00) 0.672 Comments,M (Q1,Q3) 2.00 (0.00,14.00) 1.50 (0.00,16.50) 13.00 (2.00,55.00) 0.002 Shares,M (Q1,Q3) 3.00 (0.00,27.00) 8.50 (3.00,50.50) 27.00 (6.00,120.00) 0.026 GQS score,M (Q1,Q3) 2.00 (2.00,2.00) 3.00 (3.00,4.00) 3.00 (3.00,3.00) < 0.001 mDISCERN score,M (Q1,Q3) 2.00 (2.00,3.00) 3.00 (2.00,3.00) 3.00 (2.00,3.00) < 0.001 Content completeness score, M (Q₁, Q₃) 1.00 (1.00,2.00) 3.00 (2.00,6.75) 2.00 (2.00,4.00) < .001 Uploader characteristics Specialist physicians uploaded 72.67% of the videos, while Non-Specialist physicians contributed 12.21% and Institutions 15.12% (Fig. 2 A). On TikTok, 98% of acute cholecystitis–related videos were uploaded by Specialist physicians, with Institutions accounting for only 2%. On Bilibili, Specialist physicians remained the predominant uploader group, contributing 44% of the videos, followed by Institutions at 30% and Non-Specialist physicians at 26% (Fig. 2 B). Video Content In terms of video content, Table 3 showed an analysis of 172 videos on Acute cholecystitis revealed that the mention rate of clinical manifestations was the highest, with 113 videos (65.7%), followed by treatment-related content, with 105 videos (61.05%). The mention rate of diagnostic content was 35.47% (61 videos), and that of etiology was 31.4% (54 videos). The coverage of prevention-related content was relatively low, at only 18.6% (32 videos). Epidemiological content appeared least frequently in only 9 videos(5.23%). The distribution of video content on different platforms was aslo illustrated in Fig. 3 . Video Quality, Reliability, and Content Completeness Score Overall, the median GQS score for all videos was 3.00 (IQR: 2.00–3.00), and the median mDISCERN score was likewise 3.00 (IQR: 2.00–3.00). The median score for content completeness was 2.00 (IQR: 2.00–4.00), as shown in Table 3 . GQS, mDISCERN and content completeness scores did not differ significantly between the two platforms.. On TikTok, the median GQS score was 3.00 (IQR: 3.00–3.00), the median mDISCERN score was 3.00 (IQR: 2.00–3.00), and the median content completeness score was 3.00 (IQR: 2.00–4.00) (Table 4 ). Compared with non-specialist physicians, videos uploaded by specialist physicians and institutions had higher GQS scores ( p < 0.05, Fig. 4 A), higher mDISCERN scores ( p < 0.05, Fig. 4 B), and higher content completeness score ( p < 0.05, Fig. 4 C). With respect to content completeness, videos uploaded by institutions achieved the highest scores ( p < 0.05, Fig. 4 C). For videos uploaded by specialist physicians, the median GQS score was 3.00 (IQR: 3.00–3.00), the median mDISCERN score was 3.00 (IQR: 2.00–3.00), and the median content completeness score was 2.00 (IQR: 2.00–4.00). The corresponding scores for other uploader groups are summarized in Table 5 . Correlation analysis Figure 5 shows the correlation between video duration, interaction metrics, and video quality and reliability. A weak positive correlation was observed between video duration and GQS score (ρ = 0.17, p < 0.05), mDISCERN score (ρ = 0.16, p < 0.05), and content completeness score (ρ = 0.28, p < 0.05). Additionally, likes were positively correlated with comments (ρ = 0.84, p < 0.05), shares (ρ = 0.93, p < 0.05), and collections (ρ = 0.84, p < 0.05). Comments also showed positive correlations with shares (ρ = 0.96, p < 0.05) and collections (ρ = 0.90, p < 0.05). Similarly, shares were positively correlated with collections (ρ = 0.94, p < 0.05). GQS scores and mDISCERN scores also demonstrated a weak positive correlation (ρ = 0.55, p 0.05). Discussion Our findings reveal that AC-related videos on TikTok and Bilibili predominantly focus on clinical manifestations and treatment, yet their overall quality and reliability remain suboptimal. The findings showed that the video content was mainly focused on clinical manifestations and treatment, while overall video quality and reliability were suboptimal. Compared with Bilibili, TikTok had higher levels of user engagement in terms of likes, comments, and shares; however, there were no significant differences between the two platforms in video quality, reliability, or content completeness score. Videos uploaded by specialist physicians and institutional accounts achieved higher scores in quality, reliability, and content completeness than those uploaded by non-specialist physicians, with institutional accounts demonstrating the highest content completeness score. Finally, no correlation was observed between user engagement indicators and video quality or reliability. These results underscore the need to strengthen platform oversight of health-related video content, encourage greater participation of specialist physicians and medical institutions in the production of AC-related videos, and optimize health communication strategies to promote the dissemination of high-quality videos. Video content analysis Among the short videos analyzed, clinical manifestations and treatment emerged as the most commonly covered topics. Because timely recognition and intervention are critical in acute cholecystitis, disseminating this type of information may help raise public awareness and encourage earlier healthcare-seeking. However, content related to epidemiological characteristics, etiological factors, and preventive measures was comparatively scarce. The paucity of epidemiological and preventive messaging may limit the capacity of short-form video platforms to promote preventive health behaviors and thus constrain efforts to reduce disease burden [ 23 – 25 ] . Future short-form videos should continue to address clinical recognition and management, but also systematically include information on risk factors, susceptible populations, and prevention strategies. Doing so would strengthen public awareness and support more comprehensive health education. Overall Video Quality, Reliability, and Content Completeness Score The suboptimal quality and reliability observed here align with previous reports on health-related short videos. A study on gonorrhea-related videos indicated that content on TikTok had low quality and reliability [ 26 ] , and Qi et al. reported that videos related to bipolar disorder on TikTok and Bilibili were also of inadequate quality and reliability [ 27 ] . Potential reasons for these deficiencies include low barriers for content upload, recommendation algorithms favoring highly engaging but not necessarily evidence-based content, and limited medical oversight on the platforms. It is therefore recommended that platforms strengthen the review and supervision of health-related videos, implement mechanisms for medical expert review or source verification, and promote the dissemination of trustworthy health information to protect public health. Different uploaders Video Quality, Reliability, and Content Completeness Score On TikTok, specialist physicians uploaded 98% of AC-related videos, suggesting relatively strict identity verification and concentrated content production. In contrast, Bilibili showed greater uploader diversity-26% from non-specialist physicians and 30% from institutions-which may reflect less stringent verification mechanisms. Specialist physicians also achieved higher GQS, mDISCERN [ 28 ] , and content completeness scores than non-specialist physicians, indicating that professional background significantly influences content quality and reliability. This is consistent with prior studies showing that professional content tends to be more scientific and standardized [ 29 – 30 ] . Institutional uploaders had the highest content completeness scores, likely due to their access to diverse professional expertise, greater clinical experience, and stricter internal review processes that ensure accuracy and comprehensiveness [ 31 ] . Correlation analysis Engagement metrics (likes, comments, favorites, shares) were positively correlated with each other, suggesting that videos with high interaction tend to perform consistently across multiple engagement dimensions. No association was found between engagement metrics and GQS or mDISCERN scores, indicating that user interaction likely reflects popularity rather than content quality. This is congruent with previous findings [ 22 , 29 ] . The correlation analysis demonstrated a small positive correlation between video length and GQS, mDISCERN and video content completeness score indicating that longer videos provide greater completeness and more high-quality information than shorter videos possibly due to the longer time frame providing additional opportunities to elaborate on the medical content. This finding is consistent with some previous studies, including Lei et al. (2025) [ 22 ] . The weak correlation seen in the current study may have been attributable to the fact that video creators used the additional time to create videos differently based on the specific characteristics of their content thus while use of video length may aid in the improvement of the quality of information provided, it may not have any definitive impact on reliability or educational value of the video presentation therefore it is essential to use multiple indicators in order to fully evaluate the various dimensions of video quality. Limitations This study has several limitations. First, the data were derived exclusively from domestic short-video platforms (TikTok and Bilibili), without including international platforms such as YouTube. Therefore, the findings may not be readily generalizable to platforms operating under different cultural or regulatory contexts. Second, the relatively small sample size limits the robustness of the statistical findings and representativeness. In addition, although validated instruments such as GQS and mDISCERN were used, the scoring process inevitably involved a degree of subjectivity. Finally, as a cross-sectional study, this work cannot capture temporal or longitudinal changes in the quality and reliability of videos related to acute cholecystitis. Conclusion This cross-sectional study evaluated the quality, reliability, and content completeness of short videos related to AC on TikTok and Bilibili. The video content was mainly focused on clinical manifestations and treatment, while overall scores for video quality, reliability, and content completeness were suboptimal. There were no significant differences in video quality or reliability between the two platforms. Compared with videos uploaded by non-specialist physicians, those uploaded by specialist physicians achieved higher scores in quality, reliability, and content completeness, and videos uploaded by institutional accounts had the highest content completeness score. Notably, user engagement indicators were not correlated with video quality, reliability, or content completeness. These findings highlight the need to strengthen platform regulation, encourage greater involvement of healthcare Specialist physicians in health-related content creation, and enhance public health literacy to promote the dissemination of high-quality videos. Declarations Author contributions Conceptualization: Hong-yan Ma , Tie-song Wu, Hao Song, Rong Bai Methodology: Hao Song; Formal Analysis: Hao Song; Data Curation: Rong Bai; Investigation: Tie-song Wu; Writing – Original Draft: Hong-yan Ma; Writing – Review & Editing: Rong Bai; Supervision: Hong-yan Ma; Project Administration: Tie-song Wu; All authors have read and approved the final manuscript. Funding District-level scientific research project of medical and health institutions in Longhua District, Shenzhen (2025017). Conflicting interests The authors declare no competing interests. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not applicable. Ethics approval Clinical datasets, human samples, and laboratory animals were not employed in the present research. All relevant information was obtained from openly accessible TikTok and Bilibili video resources, with the collected data posing no threats to individual privacy. Furthermore, since this study involved no direct engagement with platform users, formal ethical approval was deemed unnecessary. Guarantor Hong-yan Ma and Rong Bai. Data availability statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. References Vural S, Aydin I, Kesicioglu T. Association of serum C-reactive protein level and treatment duration in acute cholecystitis patients treated conservatively. Cureus. 2022;14(2):e22146. https://doi.org/10.7759/cureus.22146 Wang H, Gong J, Chen J, Zhang W, Sun Y, Sun D. Intestinal microbiota and biliary system diseases. Front Cell Infect Microbiol. 2024;14:1362933. https://doi.org/10.3389/fcimb.2024.1362933 Lee SK, Lee SC, Park JW, Kim SJ. The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study. BMC Surg. 2014;14(1):100. https://doi.org/10.1186/1471-2482-14-100 Sato N, Kinoshita A, Imai N, Akasu T, Yokota T, Iwaku A, et al. Inflammation-based prognostic scores predict disease severity in patients with acute cholecystitis. Eur J Gastroenterol Hepatol. 2018;30(4):484–9. https://doi.org/10.1097/MEG.0000000000001063 Strömberg J, Sadr-Azodi O, Videhult P, Hammarqvist F, Sandblom G. Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy. Langenbecks Arch Surg. 2015;400(4):463–9. https://doi.org/10.1007/s00423-015-1284-0 Borges FK, Nenshi R, Serrano PE, Engels P, Vogt K, Park LJ, et al. Fast track pathway to accelerated cholecystectomy versus standard of care for acute cholecystitis (FAST) pilot trial. Can J Surg. 2025;68(2):E122–31. https://doi.org/10.1503/cjs.016423 De Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Nathens AB. A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. J Trauma Acute Care Surg. 2013;74(1):26–31. https://doi.org/10.1097/TA.0b013e3182788e4d Dewana AM, Namq AJ, Ahmed BS, Baban AA. Optimal timing for cholecystectomy: unveiling insights from a decade-long study on acute cholecystitis and symptomatic cholecystolithiasis. BMC Surg. 2025;25(1):199. https://doi.org/10.1186/s12893-025-02851-7 Chen J, Wang Y. Social media use for health purposes: systematic review. J Med Internet Res. 2021;23(5):e17917. https://doi.org/10.2196/17917 Ghalavand H, Nabiolahi A. Exploring online health information quality criteria on social media: a mixed method approach. BMC Health Serv Res. 2024;24(1):1311. https://doi.org/10.1186/s12913-024-11838-8 Tan W, Liu Y, Shi Z, Zheng B, Feng L, Wang J, et al. Information quality of videos related to Helicobacter pylori infection on TikTok: cross-sectional study. Helicobacter. 2024;29(1):e13029. https://doi.org/10.1111/hel.13029 Chen J, Wang Y,. Social media use for health purposes: systematic review. J Med Internet Res. 2021;23(5):e17917. https://doi.org/10.2196/17917 Fisher JH, O’Connor D, Flexman AM, Shapera S, Ryerson CJ. Accuracy and reliability of internet resources for information on idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2016;194(2):218–25. https://doi.org/10.1164/rccm.201512-2393OC Stahl M, Cheung J, Post K, Valin JP, Jacobs I. Accelerating virtual health implementation following the COVID-19 pandemic: questionnaire study. JMIR Form Res. 2022;6(5):e32819. https://doi.org/10.2196/32819 Sun F, Zheng S, Wu J. Quality of information in gallstone disease videos on TikTok: cross-sectional study. J Med Internet Res. 2023;25:e39162. https://doi.org/10.2196/39162 Zheng S, Tong X, Wan D, Hu C, Hu Q, Ke Q. Quality and reliability of liver cancer-related short Chinese videos on TikTok and Bilibili: cross-sectional content analysis study. J Med Internet Res. 2023;25:e47210. https://doi.org/10.2196/47210 Du RC, Zhang Y, Wang MH, Lu NH, Hu Y. TikTok and Bilibili as sources of information on Helicobacter pylori in China: a content and quality analysis. Helicobacter. 2023;28(5):e13007. https://doi.org/10.1111/hel.13007 Kanzow P, Büttcher AF, Wiegand A, Schwendicke F. Quality of information regarding repair restorations on dentist websites: systematic search and analysis. J Med Internet Res. 2020;22(4):e17250. https://doi.org/10.2196/17250 Venosa M, Tarantino A, Schettini I, Padua R, Cifone MG, Calvisi V, et al. Stem cells in orthopedic web information: An assessment with the DISCERN tool. Cartilage. 2021;13(1_suppl):519S–25S. https://doi.org/10.1177/19476035211040161 Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. 1999;53(2):105–11. https://doi.org/10.1136/jech.53.2.105 Velasquez J, Mohammed-Norgan M, Scheiber A, Chalif J, Gonzalez A, Glassman D, et al. Cross-language insights: comparing Spanish and English-language cervical cancer content on TikTok. Gynecol Oncol. 2025;194:131–6. https://doi.org/10.1016/j.ygyno.2025.03.084 Xu R, Ren Y, Li X, Su L, Su J. The quality and reliability of short videos about premature ovarian failure on Bilibili and TikTok: cross-sectional study. Digit Health. 2025;11:1–10. https://doi.org/10.1177/20552076251351077 Gallaher JR, Charles A. Acute cholecystitis: a review. JAMA. 2022;327(10):965–75. https://doi.org/10.1001/jama.2022.2350 Ukegjini K, Schmied BM. Diagnostik und behandlung der akuten cholezystitis. Ther Umsch. 2020;77(4):133–46. https://doi.org/10.1024/0040-5930/a001168 Bagla P, Sarria JC, Riall TS. Management of acute cholecystitis. Curr Opin Infect Dis. 2016;29(5):508–13. https://doi.org/10.1097/qco.0000000000000297 Zhao K, Yang J, Liu J. The quality and content of gonorrhea-related short videos on TikTok: a cross-sectional study. Digit Health. 2025;11:1–10. https://doi.org/10.1177/20552076251391170 Qi X, Lu Q, Li B, Liu S, Zhang L, Xiang R, et al. Videos in short video sharing platforms as a source of information on bipolar disorder: a cross-sectional content analysis study. Front Public Health. 2025;13:1627885. https://doi.org/10.3389/fpubh.2025.1627885 Baun H, Cerri-Droz P, Khan S, Alper D, Rao B. A cross-sectional analysis of Tiktok’s most popular dermal filler videos. Skin Health Dis. 2024;4(4):e390. https://doi.org/10.1002/ski2.390 Tu J, Zhang C, Zhang H, Liang L, He J. Evaluating the reliability and quality of knee osteoarthritis educational content on TikTok and Bilibili: a cross-sectional content analysis. Digit Health. 2025;11:1–14. https://doi.org/10.1177/20552076251366390 Kong W, Song S, Zhao YC, Zhu Q, Sha L. TikTok as a health information source: assessment of the quality of information in diabetes-related videos. J Med Internet Res. 2021;23(9):e30409. https://doi.org/10.2196/30409 Wang J, Liu B, Yang G, Luo Y, Lv N, Shu X, et al. Assessing the content and quality of GI bleeding information on Bilibili, TikTok, and YouTube: a cross-sectional study. Sci Rep. 2025;15(1):14856. https://doi.org/10.1038/s41598-025-98364-7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 05 May, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers invited by journal 22 Apr, 2026 Editor invited by journal 02 Apr, 2026 Editor assigned by journal 01 Apr, 2026 Submission checks completed at journal 01 Apr, 2026 First submitted to journal 31 Mar, 2026 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9276663","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":632073890,"identity":"ab5240e4-09e7-42f7-9e61-d8a077c8cea3","order_by":0,"name":"Hong-yan Ma","email":"","orcid":"","institution":"Shenzhen Longhua District Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hong-yan","middleName":"","lastName":"Ma","suffix":""},{"id":632073891,"identity":"8cba305c-4d36-4218-91ab-2fffffba2467","order_by":1,"name":"Tie-song Wu","email":"","orcid":"","institution":"Shenzhen Longhua District Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tie-song","middleName":"","lastName":"Wu","suffix":""},{"id":632073892,"identity":"4f5b253e-3b77-4abd-911f-5cc41cc72fa9","order_by":2,"name":"Hao Song","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYJACZijN+IDBgEQtzAYka2GTIEq5fHvv4dcFNTbyuu3tzyp/FNyRZ2A/fHQDPi0GZ86lWc84lma47cwZs9s8Bs8MG3jS0m7g1SKRY2bMw3aYcduNHLbbDAaHGRskeMzwapGfAdLy77D9thvpzwp/GBy2J6iF4UaO8WPetsOJ224kmDHwGBxOJKjFAOgFZt6+tGSgX4ylgVqS2wj5Rb69x/gzzzcb223H2x9+/PHnsG0/++Fj+B2GER1sBJSDAPMHIhSNglEwCkbBSAYAUmJMAWwsH8AAAAAASUVORK5CYII=","orcid":"","institution":"Shenzhen Hospital of Southern Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hao","middleName":"","lastName":"Song","suffix":""},{"id":632073893,"identity":"bebf7c2c-4f96-4451-a937-29564a52b0b5","order_by":3,"name":"Rong Bai","email":"","orcid":"","institution":"Shanghai East Hospital, School of Life Sciences and Technology, Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Bai","suffix":""}],"badges":[],"createdAt":"2026-03-31 08:12:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9276663/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9276663/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108231745,"identity":"3fad8df4-b854-41df-aa0e-c89fa0fd41d0","added_by":"auto","created_at":"2026-04-30 17:48:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":277792,"visible":true,"origin":"","legend":"\u003cp\u003eSearch strategy and video filtering program.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9276663/v1/70d66e530c861adfa774fb66.png"},{"id":108231746,"identity":"e8601e0c-b82b-467b-8f76-b7276a856aa5","added_by":"auto","created_at":"2026-04-30 17:48:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":98883,"visible":true,"origin":"","legend":"\u003cp\u003eUploader types information on AC-related videos from TikTok and Bilibili. (a) Circular Pie chart showing the percentage of uploader types on all platforms (b), percentage stacked bar chart showing the percentage of uploader types on different platforms (TikTok and Bilibili). AC: acute cholecystitis.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9276663/v1/0e9283a60ef278714b89aae1.png"},{"id":108491738,"identity":"83e915b2-2473-4ddf-a6f7-d5ab349367bd","added_by":"auto","created_at":"2026-05-05 09:55:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":104907,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of video content between TikTok and Bilibili.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9276663/v1/7434f639d66296b0c0108a97.png"},{"id":108231748,"identity":"0830b061-396a-4dde-ac0e-1744df23f82f","added_by":"auto","created_at":"2026-04-30 17:48:45","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":150109,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of quality and reliability scores across different types of uploader groups. (a) GQS score. (b) mDISCERN score. (c) content completeness score.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-9276663/v1/034dc7e3f96c187bc1a76014.png"},{"id":108491135,"identity":"dbe33fc6-199e-4d0e-b935-e313646f9d4a","added_by":"auto","created_at":"2026-05-05 09:52:28","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":235586,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation matrix of Spearman’s correlation analysis between video metrics and quality scores.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-9276663/v1/8b9793951d103ad5d92a4cc1.png"},{"id":108492776,"identity":"3dd3ae7b-015f-4693-82a3-2091f4d07aec","added_by":"auto","created_at":"2026-05-05 09:58:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1150298,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9276663/v1/6a575b61-d539-425a-b625-c67a4a333c9b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the reliability and quality of Acute cholecystitis educational contenton TikTok and Bilibili: A cross-sectionalcontent analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute cholecystitis (AC) is an acute inflammatory condition of the gallbladder that typically presents with right upper abdominal pain, fever, and elevated white blood cell count, and is one of the most common causes of acute abdominal emergencies\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. AC can significantly impair patients\u0026rsquo; quality of life and may progress to severe complications such as gallbladder gangrene, perforation, abscess formation or systemic inflammatory responses, thereby increasing both clinical and economic burdens\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. AC may also induce inflammatory activation, hypercoagulability or heightened stress responses, resulting in downstream complications including thrombosis, stroke or renal injury. Individuals with recurrent symptom episodes are at elevated risk of developing biliary colic, biliary obstruction or pancreatitis\u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Access to accurate, timely, and reliable health information is therefore critical\u0026mdash;not only for promoting prevention and early recognition, but also for guiding appropriate healthcare-seeking and informed decision-making.\u003c/p\u003e \u003cp\u003eShort-video platforms have rapidly transformed how the public accesses medical information, offering visually engaging content and broad reach\u0026mdash;particularly among younger audiences\u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Platforms such as TikTok and Bilibili offer rapid dissemination, visually engaging formats, and strong interactivity, enabling large audiences, particularly younger users, to access abundant health-related information within a short period\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. However, the low threshold for content creation and the lack of rigorous medical review contribute to substantial variability in information quality, including inaccurate or misleading content\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Previous studies have identified unverified or unreliable health information in videos addressing conditions such as idiopathic pulmonary fibrosis, COVID-19, helicobacter pylori, gallstone disease, and liver cancer\u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Given the relatively high incidence of AC, its potential for serious complications, and the harmful consequences of delayed diagnosis, exposure to low-quality online video content may impede timely disease recognition and appropriate healthcare-seeking behavior. These concerns underscore the importance of systematically evaluating the quality and reliability of AC-related videos on these platforms.In this study, we assess the quality and reliability of AC-related videos on TikTok and Bilibili, comparing content across platforms and uploader types. Our findings are intended to highlight current gaps in digital health communication and offer evidence to guide improvements in content governance and patient education.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Retrieval\u003c/h2\u003e \u003cp\u003eSearches were conducted on TikTok and Bilibili on October 14, 2025, using the Chinese keyword \u0026ldquo;急性胆囊炎\u0026rdquo; (\u0026ldquo;acute cholecystitis\u0026rdquo;). To minimize the influence of personalized recommendation algorithms, browser history was cleared and newly registered accounts were used for the searches. In the initial screening phase, the top 100 videos and the top 100 video sranked under TikTok and Bilibili platform\u0026rsquo;s comprehensive sorting criteria were retrieved for further evaluation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were: (1) videos related to acute cholecystitis (AC); and (2) videos presented in Chinese. The exclusion criteria were: (1) videos unrelated to AC; (2) advertisements or promotional content; (3) duplicate or re uploaded videos; (4) videos with poor audiovisual quality that impeded comprehension; and (5) videos uploaded within one week prior to data collection. A total of 172 videos met the inclusion criteria and were included in the final analysis, and the detailed screening process is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eData Extraction and Classification\u003c/h3\u003e\n\u003cp\u003eFor each video, the following data were collected: platform source, video duration (seconds), number of likes, number of comments, number of favorites, number of shares, uploader type, and video content. Uploaders were categorized as Specialist physicians, non-specialist physicians, or institutions. Specialist physicians included hepatobiliary surgeons, general surgeons, and related specialists, whereas non-specialist physicians included traditional Chinese medicine physicians, radiologists, and emergency surgeons. Institutional uploaders comprised medical colleges and universities, educational organizations, and official accounts. Video content was classified into six categories: epidemiology, etiology, clinical manifestations, diagnosis, treatment, and prevention.\u003c/p\u003e\n\u003ch3\u003eQuality and Reliability Assessment\u003c/h3\u003e\n\u003cp\u003eThe GQS quantifies online video quality using a five-tier grading system, with scores ranging from 1 (poor) to 5 (excellent)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. The mDISCERN instrument, originally developed for evaluating written health materials, has been adapted to assess the reliability of video content\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. This modified tool employs a five-item questionnaire with a scoring scale of 1–5, where elevated scores correspond to enhanced content reliability. The detailed scoring criteria for these two instruments are presented in Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The completeness of video content is scored based on whether it covers the key aspects of AC (such as epidemiology, etiology, clinical manifestations, diagnosis, treatment, and prevention). Each item of the video content score ranges from 0 to 2 points (0 point: not covered, 1 point: partially covered, 2 points: complete coverage), the total score of the collected video content completeness is the sum of the scores of the above five items. The above GQS, mDISCERN and Content Completeness Score\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e were independently completed by two evaluators with clinical backgrounds in hepatobiliary surgery or related specialties (including 1 hepatobiliary surgery clinician and 1 hepatobiliary surgery clinical pharmacist). In case of disagreement, the third professional in the relevant field (a hepatobiliary surgery clinical pharmacist) made the ruling.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Global Quality Score (GQS) quality criteria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eItem features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePoints\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePoor quality; poor flow of the videos; most information missing; not at all useful for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGenerally poor quality; some information listed, but many important topics missing; of very limited use to patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eModerate quality; suboptimal flow; some important adequately discussed, but other information poorly discussed; somewhat useful for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGood quality and generally good flow; most of the relevant information listed, but some topics not covered; useful for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExcellent quality and flow; very useful for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Modified DISCERN (mDISCERN) quality criteria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eReliability Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1. Is the video clear, concise, and understandable?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2. Are valid sources cited?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3. Is the content presented balanced and unbiased?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e4. Are additional sources of content listed for patient reference?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5. Are areas of uncertainty mentioned?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistical methods were used to summarize the continuous variables. Data with normal distribution were expressed as mean ± standard deviation (SD), while data with non-normal distribution were expressed as median and interquartile range (IQR). Categorical variables were expressed as frequency and percentage. When comparing groups, variables with normal distribution were analyzed using the independent sample t-test, and variables with non-normal distribution were analyzed using the Mann–Whitney U test. Comparisons of three or more groups were performed using the Kruskal–Wallis H test, and when the differences were statistically significant, pairwise comparisons were further conducted using Dunn's test. Spearman rank correlation coefficient was used to evaluate the correlation between video quality scores (GQS and mDISCERN) and interaction indicators (likes, comments, shares, and favorites). A two-sided \u003cem\u003eP\u003c/em\u003e value \u0026lt; 0.05 was considered statistically significant. All statistical analyses and graphical visualizations were performed using R software (version 4.3.2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003eGeneral feature description of the video\u003c/h2\u003e\u003cp\u003eAfter applying the inclusion and exclusion criteria, 172 videos were included in the final analysis—81 (47.1%) from Bilibili and 91 (52.9%) from TikTok. Of these, 81 (47.1%) were from Bilibili and 91 (52.9%) from TikTok. Analysis of the overall video features showed that the median video length is 97.00s (IQR: 61.00-204.25). The median number of likes was 81.50 (IQR: 21.75–426.00), the median number of Collections is 35.50 (IQR: 10.00-171.50), the median number of comments is 9.50 (IQR: 1.00–35.00), and the median number of shares is 18.50 (IQR: 3.00-109.00), as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Characteristics, Quality, and Reliability of the Acute cholecystitis Videos.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eTotal (n = 172 )\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eGeneral information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVideo length(s),M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e97.00 (61.00, 204.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLikes,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e81.50 (21.75, 426.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCollections,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e35.50 (10.00, 171.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComments,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e9.50 (1.00, 35.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eShares,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18.50 (3.00, 109.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eVideo content\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eepidemiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e9(5.23%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e54(31.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClinical manifestation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e113(65.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e61(35.47%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e105(61.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePrevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e32(18.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eVideo quality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGQS score,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003emDISCERN score,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003econtent completeness score, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (2.00, 4.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCompared with Bilibili, videos on TikTok were shorter in duration (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05) but received higher numbers of likes, comments, and shares (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). On TikTok, the median video length was 71.00 (IQR: 47.50–106.00), the median number of likes was 208.00 (IQR: 63.00-764.00), the median number of collections is 53.00 (IQR: 12.00-267.50), the median number of comments was 19.00 (IQR: 8.00-72.50), and the median number of shares was 35.00 (IQR: 11.00-173.00) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Information, Quality, and Reliability Scores of Acute cholecystitis Videos on TikTok and Bilibili.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eBilibili (n = 81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eTikTok (n = 91)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eGeneral information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVideo length(s),M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e223.00 (93.00, 620.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e71.00 (47.50, 106.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLikes,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e22.00 (6.00, 101.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e208.00 (63.00, 764.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCollections,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e29.00 (5.00, 143.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e53.00 (12.00, 267.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComments,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (0.00, 13.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e19.00 (8.00, 72.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eShares,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8.00 (2.00, 36.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e35.00 (11.00, 173.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eVideo content\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEpidemiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3(3.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e27(33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e27(29.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClinical manifestation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e50(61.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e63(69.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e31(38.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e30(32.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e43(53.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e62(68.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePrevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10(12.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e22(24.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eVideo quality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGQS score,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (3.00, 3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003emDISCERN score,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003econtent completeness score, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (1.00, 4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00, 4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe median duration of videos uploaded by Specialist physicians was 84.00 (IQR: 53.00-121.00), with a median number of likes of 108.00 (IQR: 40.00-613.00), Collections is 38.00 (IQR: 10.00-179.00), comments of 13.00 (IQR: 2.00–55.00), and shares of 27.00 (IQR: 6.00-120.00). The baseline characteristics of videos uploaded by other uploader groups are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab5\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics, Quality, and Reliability of Acute cholecystitis Videos by Different Uploaders on TikTok and Bilibili.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNon-specialist physicians\u003c/p\u003e \u003cp\u003e(n = 21, 12.21%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eInstitutions\u003c/p\u003e \u003cp\u003e(n = 26, 15.12% )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eSpecialist physicians\u003c/p\u003e \u003cp\u003e(n = 125, 72.67% )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVideo length(s),M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e132.00 (72.00,348.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e610.00 (274.25,1076.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e84.00 (53.00,121.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLikes,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e17.00 (6.00,235.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e23.00 (11.00,124.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e108.00 (40.00,613.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCollections,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e23.00 (5.00,224.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e40.50 (15.50,144.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e38.00 (10.00,179.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComments,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (0.00,14.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.50 (0.00,16.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13.00 (2.00,55.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eShares,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (0.00,27.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8.50 (3.00,50.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e27.00 (6.00,120.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGQS score,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (2.00,2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (3.00,4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (3.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003emDISCERN score,M (Q1,Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (2.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eContent completeness score, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.00 (1.00,2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.00 (2.00,6.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.00 (2.00,4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\n\u003ch3\u003eUploader characteristics\u003c/h3\u003e\n\u003cp\u003eSpecialist physicians uploaded 72.67% of the videos, while Non-Specialist physicians contributed 12.21% and Institutions 15.12% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). On TikTok, 98% of acute cholecystitis\u0026ndash;related videos were uploaded by Specialist physicians, with Institutions accounting for only 2%. On Bilibili, Specialist physicians remained the predominant uploader group, contributing 44% of the videos, followed by Institutions at 30% and Non-Specialist physicians at 26% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eVideo Content\u003c/h2\u003e \u003cp\u003eIn terms of video content, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed an analysis of 172 videos on Acute cholecystitis revealed that the mention rate of clinical manifestations was the highest, with 113 videos (65.7%), followed by treatment-related content, with 105 videos (61.05%). The mention rate of diagnostic content was 35.47% (61 videos), and that of etiology was 31.4% (54 videos). The coverage of prevention-related content was relatively low, at only 18.6% (32 videos). Epidemiological content appeared least frequently in only 9 videos(5.23%). The distribution of video content on different platforms was aslo illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eVideo Quality, Reliability, and Content Completeness Score\u003c/h2\u003e \u003cp\u003eOverall, the median GQS score for all videos was 3.00 (IQR: 2.00\u0026ndash;3.00), and the median mDISCERN score was likewise 3.00 (IQR: 2.00\u0026ndash;3.00). The median score for content completeness was 2.00 (IQR: 2.00\u0026ndash;4.00), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. GQS, mDISCERN and content completeness scores did not differ significantly between the two platforms.. On TikTok, the median GQS score was 3.00 (IQR: 3.00\u0026ndash;3.00), the median mDISCERN score was 3.00 (IQR: 2.00\u0026ndash;3.00), and the median content completeness score was 3.00 (IQR: 2.00\u0026ndash;4.00) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Compared with non-specialist physicians, videos uploaded by specialist physicians and institutions had higher GQS scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA), higher mDISCERN scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB), and higher content completeness score (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC). With respect to content completeness, videos uploaded by institutions achieved the highest scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC). For videos uploaded by specialist physicians, the median GQS score was 3.00 (IQR: 3.00\u0026ndash;3.00), the median mDISCERN score was 3.00 (IQR: 2.00\u0026ndash;3.00), and the median content completeness score was 2.00 (IQR: 2.00\u0026ndash;4.00). The corresponding scores for other uploader groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the correlation between video duration, interaction metrics, and video quality and reliability. A weak positive correlation was observed between video duration and GQS score (ρ\u0026thinsp;=\u0026thinsp;0.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), mDISCERN score (ρ\u0026thinsp;=\u0026thinsp;0.16, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and content completeness score (ρ\u0026thinsp;=\u0026thinsp;0.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, likes were positively correlated with comments (ρ\u0026thinsp;=\u0026thinsp;0.84, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), shares (ρ\u0026thinsp;=\u0026thinsp;0.93, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and collections (ρ\u0026thinsp;=\u0026thinsp;0.84, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Comments also showed positive correlations with shares (ρ\u0026thinsp;=\u0026thinsp;0.96, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and collections (ρ\u0026thinsp;=\u0026thinsp;0.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, shares were positively correlated with collections (ρ\u0026thinsp;=\u0026thinsp;0.94, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). GQS scores and mDISCERN scores also demonstrated a weak positive correlation (ρ\u0026thinsp;=\u0026thinsp;0.55, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No correlation was found between interaction metrics and video quality, reliability, and content completeness scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings reveal that AC-related videos on TikTok and Bilibili predominantly focus on clinical manifestations and treatment, yet their overall quality and reliability remain suboptimal. The findings showed that the video content was mainly focused on clinical manifestations and treatment, while overall video quality and reliability were suboptimal. Compared with Bilibili, TikTok had higher levels of user engagement in terms of likes, comments, and shares; however, there were no significant differences between the two platforms in video quality, reliability, or content completeness score. Videos uploaded by specialist physicians and institutional accounts achieved higher scores in quality, reliability, and content completeness than those uploaded by non-specialist physicians, with institutional accounts demonstrating the highest content completeness score. Finally, no correlation was observed between user engagement indicators and video quality or reliability. These results underscore the need to strengthen platform oversight of health-related video content, encourage greater participation of specialist physicians and medical institutions in the production of AC-related videos, and optimize health communication strategies to promote the dissemination of high-quality videos.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eVideo content analysis\u003c/h2\u003e \u003cp\u003eAmong the short videos analyzed, clinical manifestations and treatment emerged as the most commonly covered topics. Because timely recognition and intervention are critical in acute cholecystitis, disseminating this type of information may help raise public awareness and encourage earlier healthcare-seeking. However, content related to epidemiological characteristics, etiological factors, and preventive measures was comparatively scarce. The paucity of epidemiological and preventive messaging may limit the capacity of short-form video platforms to promote preventive health behaviors and thus constrain efforts to reduce disease burden\u003csup\u003e[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Future short-form videos should continue to address clinical recognition and management, but also systematically include information on risk factors, susceptible populations, and prevention strategies. Doing so would strengthen public awareness and support more comprehensive health education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eOverall Video Quality, Reliability, and Content Completeness Score\u003c/h2\u003e \u003cp\u003eThe suboptimal quality and reliability observed here align with previous reports on health-related short videos. A study on gonorrhea-related videos indicated that content on TikTok had low quality and reliability\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, and Qi et al. reported that videos related to bipolar disorder on TikTok and Bilibili were also of inadequate quality and reliability\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Potential reasons for these deficiencies include low barriers for content upload, recommendation algorithms favoring highly engaging but not necessarily evidence-based content, and limited medical oversight on the platforms. It is therefore recommended that platforms strengthen the review and supervision of health-related videos, implement mechanisms for medical expert review or source verification, and promote the dissemination of trustworthy health information to protect public health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDifferent uploaders Video Quality, Reliability, and Content Completeness Score\u003c/h2\u003e \u003cp\u003eOn TikTok, specialist physicians uploaded 98% of AC-related videos, suggesting relatively strict identity verification and concentrated content production. In contrast, Bilibili showed greater uploader diversity-26% from non-specialist physicians and 30% from institutions-which may reflect less stringent verification mechanisms. Specialist physicians also achieved higher GQS, mDISCERN\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e, and content completeness scores than non-specialist physicians, indicating that professional background significantly influences content quality and reliability. This is consistent with prior studies showing that professional content tends to be more scientific and standardized\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Institutional uploaders had the highest content completeness scores, likely due to their access to diverse professional expertise, greater clinical experience, and stricter internal review processes that ensure accuracy and comprehensiveness\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis\u003c/h2\u003e \u003cp\u003eEngagement metrics (likes, comments, favorites, shares) were positively correlated with each other, suggesting that videos with high interaction tend to perform consistently across multiple engagement dimensions. No association was found between engagement metrics and GQS or mDISCERN scores, indicating that user interaction likely reflects popularity rather than content quality. This is congruent with previous findings \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe correlation analysis demonstrated a small positive correlation between video length and GQS, mDISCERN and video content completeness score indicating that longer videos provide greater completeness and more high-quality information than shorter videos possibly due to the longer time frame providing additional opportunities to elaborate on the medical content. This finding is consistent with some previous studies, including Lei et al. (2025)\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. The weak correlation seen in the current study may have been attributable to the fact that video creators used the additional time to create videos differently based on the specific characteristics of their content thus while use of video length may aid in the improvement of the quality of information provided, it may not have any definitive impact on reliability or educational value of the video presentation therefore it is essential to use multiple indicators in order to fully evaluate the various dimensions of video quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, the data were derived exclusively from domestic short-video platforms (TikTok and Bilibili), without including international platforms such as YouTube. Therefore, the findings may not be readily generalizable to platforms operating under different cultural or regulatory contexts. Second, the relatively small sample size limits the robustness of the statistical findings and representativeness. In addition, although validated instruments such as GQS and mDISCERN were used, the scoring process inevitably involved a degree of subjectivity. Finally, as a cross-sectional study, this work cannot capture temporal or longitudinal changes in the quality and reliability of videos related to acute cholecystitis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis cross-sectional study evaluated the quality, reliability, and content completeness of short videos related to AC on TikTok and Bilibili. The video content was mainly focused on clinical manifestations and treatment, while overall scores for video quality, reliability, and content completeness were suboptimal. There were no significant differences in video quality or reliability between the two platforms. Compared with videos uploaded by non-specialist physicians, those uploaded by specialist physicians achieved higher scores in quality, reliability, and content completeness, and videos uploaded by institutional accounts had the highest content completeness score. Notably, user engagement indicators were not correlated with video quality, reliability, or content completeness. These findings highlight the need to strengthen platform regulation, encourage greater involvement of healthcare Specialist physicians in health-related content creation, and enhance public health literacy to promote the dissemination of high-quality videos.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization:\u0026nbsp;Hong-yan Ma , Tie-song Wu, Hao Song, Rong Bai\u003c/p\u003e\n\u003cp\u003eMethodology:\u0026nbsp;Hao Song;\u0026nbsp;Formal Analysis:\u0026nbsp;Hao Song;\u0026nbsp;Data Curation:\u0026nbsp;Rong Bai;\u0026nbsp;Investigation:\u0026nbsp;Tie-song Wu;\u0026nbsp;Writing \u0026ndash; Original Draft:\u0026nbsp;Hong-yan Ma;\u0026nbsp;Writing \u0026ndash; Review \u0026amp; Editing:\u0026nbsp;Rong Bai;\u0026nbsp;Supervision:\u0026nbsp;Hong-yan Ma;\u0026nbsp;Project Administration:\u0026nbsp;Tie-song Wu;\u0026nbsp;All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDistrict-level scientific research project of medical and health institutions in Longhua District, Shenzhen (2025017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient and public involvement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical datasets, human samples, and laboratory animals were not employed in the present research. All relevant information was obtained from openly accessible TikTok and Bilibili video resources, with the collected data posing no threats to individual privacy. Furthermore, since this study involved no direct engagement with platform users, formal ethical approval was deemed unnecessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuarantor \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHong-yan Ma and Rong Bai.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVural S, Aydin I, Kesicioglu T. Association of serum C-reactive protein level and treatment duration in acute cholecystitis patients treated conservatively. Cureus. 2022;14(2):e22146. https://doi.org/10.7759/cureus.22146\u003c/li\u003e\n\u003cli\u003eWang H, Gong J, Chen J, Zhang W, Sun Y, Sun D. Intestinal microbiota and biliary system diseases. Front Cell Infect Microbiol. 2024;14:1362933. https://doi.org/10.3389/fcimb.2024.1362933\u003c/li\u003e\n\u003cli\u003eLee SK, Lee SC, Park JW, Kim SJ. The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study. BMC Surg. 2014;14(1):100. https://doi.org/10.1186/1471-2482-14-100\u003c/li\u003e\n\u003cli\u003eSato N, Kinoshita A, Imai N, Akasu T, Yokota T, Iwaku A, et al. Inflammation-based prognostic scores predict disease severity in patients with acute cholecystitis. Eur J Gastroenterol Hepatol. 2018;30(4):484\u0026ndash;9. https://doi.org/10.1097/MEG.0000000000001063\u003c/li\u003e\n\u003cli\u003eStr\u0026ouml;mberg J, Sadr-Azodi O, Videhult P, Hammarqvist F, Sandblom G. Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy. Langenbecks Arch Surg. 2015;400(4):463\u0026ndash;9. https://doi.org/10.1007/s00423-015-1284-0\u003c/li\u003e\n\u003cli\u003eBorges FK, Nenshi R, Serrano PE, Engels P, Vogt K, Park LJ, et al. Fast track pathway to accelerated cholecystectomy versus standard of care for acute cholecystitis (FAST) pilot trial. Can J Surg. 2025;68(2):E122\u0026ndash;31. https://doi.org/10.1503/cjs.016423\u003c/li\u003e\n\u003cli\u003eDe Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Nathens AB. A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. J Trauma Acute Care Surg. 2013;74(1):26\u0026ndash;31. https://doi.org/10.1097/TA.0b013e3182788e4d\u003c/li\u003e\n\u003cli\u003eDewana AM, Namq AJ, Ahmed BS, Baban AA. Optimal timing for cholecystectomy: unveiling insights from a decade-long study on acute cholecystitis and symptomatic cholecystolithiasis. BMC Surg. 2025;25(1):199. https://doi.org/10.1186/s12893-025-02851-7\u003c/li\u003e\n\u003cli\u003eChen J, Wang Y. Social media use for health purposes: systematic review. J Med Internet Res. 2021;23(5):e17917. https://doi.org/10.2196/17917\u003c/li\u003e\n\u003cli\u003eGhalavand H, Nabiolahi A. Exploring online health information quality criteria on social media: a mixed method approach. BMC Health Serv Res. 2024;24(1):1311. https://doi.org/10.1186/s12913-024-11838-8\u003c/li\u003e\n\u003cli\u003eTan W, Liu Y, Shi Z, Zheng B, Feng L, Wang J, et al. Information quality of videos related to Helicobacter pylori infection on TikTok: cross-sectional study. Helicobacter. 2024;29(1):e13029. https://doi.org/10.1111/hel.13029\u003c/li\u003e\n\u003cli\u003eChen J, Wang Y,. Social media use for health purposes: systematic review. J Med Internet Res. 2021;23(5):e17917. https://doi.org/10.2196/17917\u003c/li\u003e\n\u003cli\u003eFisher JH, O\u0026rsquo;Connor D, Flexman AM, Shapera S, Ryerson CJ. Accuracy and reliability of internet resources for information on idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2016;194(2):218\u0026ndash;25. https://doi.org/10.1164/rccm.201512-2393OC\u003c/li\u003e\n\u003cli\u003eStahl M, Cheung J, Post K, Valin JP, Jacobs I. Accelerating virtual health implementation following the COVID-19 pandemic: questionnaire study. JMIR Form Res. 2022;6(5):e32819. https://doi.org/10.2196/32819\u003c/li\u003e\n\u003cli\u003eSun F, Zheng S, Wu J. Quality of information in gallstone disease videos on TikTok: cross-sectional study. J Med Internet Res. 2023;25:e39162. https://doi.org/10.2196/39162\u003c/li\u003e\n\u003cli\u003eZheng S, Tong X, Wan D, Hu C, Hu Q, Ke Q. Quality and reliability of liver cancer-related short Chinese videos on TikTok and Bilibili: cross-sectional content analysis study. J Med Internet Res. 2023;25:e47210. https://doi.org/10.2196/47210\u003c/li\u003e\n\u003cli\u003eDu RC, Zhang Y, Wang MH, Lu NH, Hu Y. TikTok and Bilibili as sources of information on Helicobacter pylori in China: a content and quality analysis. Helicobacter. 2023;28(5):e13007. https://doi.org/10.1111/hel.13007\u003c/li\u003e\n\u003cli\u003eKanzow P, B\u0026uuml;ttcher AF, Wiegand A, Schwendicke F. Quality of information regarding repair restorations on dentist websites: systematic search and analysis. J Med Internet Res. 2020;22(4):e17250. https://doi.org/10.2196/17250\u003c/li\u003e\n\u003cli\u003eVenosa M, Tarantino A, Schettini I, Padua R, Cifone MG, Calvisi V, et al. Stem cells in orthopedic web information: An assessment with the DISCERN tool. Cartilage. 2021;13(1_suppl):519S\u0026ndash;25S. https://doi.org/10.1177/19476035211040161\u003c/li\u003e\n\u003cli\u003eCharnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. 1999;53(2):105\u0026ndash;11. https://doi.org/10.1136/jech.53.2.105\u003c/li\u003e\n\u003cli\u003eVelasquez J, Mohammed-Norgan M, Scheiber A, Chalif J, Gonzalez A, Glassman D, et al. Cross-language insights: comparing Spanish and English-language cervical cancer content on TikTok. Gynecol Oncol. 2025;194:131\u0026ndash;6. https://doi.org/10.1016/j.ygyno.2025.03.084\u003c/li\u003e\n\u003cli\u003eXu R, Ren Y, Li X, Su L, Su J. The quality and reliability of short videos about premature ovarian failure on Bilibili and TikTok: cross-sectional study. Digit Health. 2025;11:1\u0026ndash;10. https://doi.org/10.1177/20552076251351077\u003c/li\u003e\n\u003cli\u003eGallaher JR, Charles A. Acute cholecystitis: a review. JAMA. 2022;327(10):965\u0026ndash;75. https://doi.org/10.1001/jama.2022.2350\u003c/li\u003e\n\u003cli\u003eUkegjini K, Schmied BM. Diagnostik und behandlung der akuten cholezystitis. Ther Umsch. 2020;77(4):133\u0026ndash;46. https://doi.org/10.1024/0040-5930/a001168\u003c/li\u003e\n\u003cli\u003eBagla P, Sarria JC, Riall TS. Management of acute cholecystitis. Curr Opin Infect Dis. 2016;29(5):508\u0026ndash;13. https://doi.org/10.1097/qco.0000000000000297\u003c/li\u003e\n\u003cli\u003eZhao K, Yang J, Liu J. The quality and content of gonorrhea-related short videos on TikTok: a cross-sectional study. Digit Health. 2025;11:1\u0026ndash;10. https://doi.org/10.1177/20552076251391170\u003c/li\u003e\n\u003cli\u003eQi X, Lu Q, Li B, Liu S, Zhang L, Xiang R, et al. Videos in short video sharing platforms as a source of information on bipolar disorder: a cross-sectional content analysis study. Front Public Health. 2025;13:1627885. https://doi.org/10.3389/fpubh.2025.1627885\u003c/li\u003e\n\u003cli\u003eBaun H, Cerri-Droz P, Khan S, Alper D, Rao B. A cross-sectional analysis of Tiktok\u0026rsquo;s most popular dermal filler videos. Skin Health Dis. 2024;4(4):e390. https://doi.org/10.1002/ski2.390\u003c/li\u003e\n\u003cli\u003eTu J, Zhang C, Zhang H, Liang L, He J. Evaluating the reliability and quality of knee osteoarthritis educational content on TikTok and Bilibili: a cross-sectional content analysis. Digit Health. 2025;11:1\u0026ndash;14. https://doi.org/10.1177/20552076251366390\u003c/li\u003e\n\u003cli\u003eKong W, Song S, Zhao YC, Zhu Q, Sha L. TikTok as a health information source: assessment of the quality of information in diabetes-related videos. J Med Internet Res. 2021;23(9):e30409. https://doi.org/10.2196/30409\u003c/li\u003e\n\u003cli\u003eWang J, Liu B, Yang G, Luo Y, Lv N, Shu X, et al. Assessing the content and quality of GI bleeding information on Bilibili, TikTok, and YouTube: a cross-sectional study. Sci Rep. 2025;15(1):14856. https://doi.org/10.1038/s41598-025-98364-7\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-digital-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Digital Health](https://bmcdigitalhealth.biomedcentral.com/)","snPcode":"44247","submissionUrl":"https://submission.nature.com/new-submission/44247/3","title":"BMC Digital Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acute cholecystitis, Short-video platforms, Health information quality, Content analysis, Information reliability","lastPublishedDoi":"10.21203/rs.3.rs-9276663/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9276663/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTikTok and Bilibili are rapidly becoming important channels for the public to obtain health information. This study aimed to evaluate the content, quality, and reliability of videos related to acute cholecystitis (AC) on the TikTok and Bilibili platforms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing “acute cholecystitis” as the keyword, videos were retrieved and evaluated with the Global Quality Score (GQS) and modified DISCERN (mDISCERN) as well as content completeness score. The Mann–Whitney U test was used to compare differences between platforms, the Kruskal–Wallis test was applied to analyze differences among uploader groups, and Spearman rank correlation analysis was performed to explore correlations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 172 AC-related videos were included in this study. Among the videos, clinical manifestations (65.7%) and treatment (61.05%) were the most frequently covered topics, whereas prevention-related content appeared in only 18.6%. The overall median GQS score was 3.00 (IQR: 2.00-3.00), the median mDISCERN score was 3.00 (IQR: 2.00-3.00), and the median content completeness score was 2.00 (IQR: 2.00-4.00). Videos from specialist physicians and institutions scored significantly higher in quality, reliability, and content completeness than those from non-specialist physicians (*p* \u0026lt; 0.05). Engagement metrics showed no correlation with video quality or reliability (*p* \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe overall quality and reliability of AC-related videos on TikTok and Bilibili are suboptimal. In the future, supervision and regulation of AC-related content on these two platforms should be strengthened to promote the effective dissemination of high-quality health information.\u003c/p\u003e","manuscriptTitle":"Evaluating the reliability and quality of Acute cholecystitis educational contenton TikTok and Bilibili: A cross-sectionalcontent analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 17:48:41","doi":"10.21203/rs.3.rs-9276663/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-05T16:30:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251529543738842867153586561632846398041","date":"2026-04-22T16:54:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T07:07:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T04:48:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-01T12:23:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-01T12:22:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Digital Health","date":"2026-03-31T07:55:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-digital-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Digital Health](https://bmcdigitalhealth.biomedcentral.com/)","snPcode":"44247","submissionUrl":"https://submission.nature.com/new-submission/44247/3","title":"BMC Digital Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bda81e5b-b74e-483b-8cce-955e46b8c754","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-05T16:30:00+00:00","index":54,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T17:48:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 17:48:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9276663","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9276663","identity":"rs-9276663","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}