TikTok's Role in HPV Education: A Content Analysis

Introduction 

Patients receive much of their medical information from the Internet, which can shape their attitudes towards medical interventions.1 Social media platforms such as TikTok, a video sharing site, have become increasingly popular for the dissemination of information related to healthcare and patient experiences, specifically within gynaecology.2 3 Many studies investigating online medical information are outdated, and new platforms such as TikTok have not been extensively studied.4 The primary aim of our study was to describe the content on TikTok related to cervical cancer screening. Secondary aims included analysis of perceived benefits of and barriers to pursuing screening. Our goals were to arm providers with the knowledge of the type of online content to which patients may be exposed and to inform them of potential avenues for patient outreach and education.

Methods 

We identified the 50 most viewed, English language videos on TikTok that included the hashtags #HPV and #papsmear on 5 August 2023. These terms were searched using a newly created account to diminish the algorithmic bias associated with using a pre-existing account. Two independent reviewers analysed the videos; one was an obstetrics-gynaecology (OBGYN) resident and another was a GYN oncology fellow. Each video was categorised as educational, experiential (related to the creator’s lived experience), humorous or a combination. Video demographics included the number of views, likes, shares and comments. Creator demographics included whether the creator was a healthcare professional (HP). Each video was analysed independently by the two reviewers to identify if its overall tone was positive or negative. The videos were also analysed for the presence of predetermined themes such as distrust of medicine, lack of understanding (expressed explicitly by the video creator), medical education/demonstration, benefits of screening and early detection, benefits of vaccination, fear/pain, racism/discrimination and socioeconomic barriers. These themes were selected as they represented either motivating reasons for or existing barriers to seeking care, which have been reliably described in the literature.5 Lastly, videos were assessed for medical accuracy and scored for understandability and actionability based on the Patient Education Materials Assessment Tool (PEMAT), a validated tool used to assess whether patient education materials are easy to understand and outline actionable steps for the viewer.6 Discrepancies between reviewers were mediated by a third reviewer, who was an OBGYN resident.

Results 

The selected videos had 23.3 million views, 636.8 thousand likes, 43.1 thousand shares and 22.1 thousand comments (table 1). Prior to mediation by a third reviewer, there was only a 4% discrepancy in categorisation and thematic analysis by the two initial reviewers. The majority of videos were primarily educational (72%), with a minority being primarily experiential (28%). 58% of the videos were created by HPs, and 90% included medically accurate claims. Specifically, among videos created by non-HPs (NHPs), 81% contained accurate information. The videos had an average understandability of 87.5% and average actionability of 40.5%.

Overall, 48% of videos had a positive tone, 34% had a negative tone and 18% were neutral. 89% of videos with a negative tone were created by NHPs. In terms of prominent themes, benefits of early screening were represented in 46% of videos, medical education in 22% and benefits of vaccination in 12% of videos. Fear, pain and discomfort appeared in 24% of videos, distrust of medicine in 10% of videos and lack of understanding of medical procedures in 10% of videos. This data is summarised in table 2.

Discussion 

Our primary aim was to quantify and describe content available on TikTok related to pap smears, human papillomavirus (HPV infection and colposcopy. The 50 most-viewed videos analysed in our study had a total of over 23 million views collectively. Such popularity is a testament to the growing use of TikTok as a method of acquiring medical information. These videos are liked, shared and commented on by thousands of individuals, highlighting the importance of using social media as an opportunity for medical providers to disseminate information and improve patient health literacy.

Regarding creator demographics and accuracy in content, we found that most videos were created by HPs, and most had factually correct information (100% by HPs, 81% by NHPs). The large percentage of medically accurate videos created by NHPs refutes the misconception that information shared online is overwhelmingly inaccurate. It is important to mention, however, that this is a relatively small sample and may not be indicative of all online content. Additionally, the field of medicine is constantly changing, so there is no way to ensure information online remains updated.

Similarly, while videos made by NHPs had a high PEMAT understandability rating (82%), they had lower actionability scores than videos made by HPs (36% vs 44%). This indicates that while these videos provide digestible information, they do not necessarily provide counselling regarding next steps. This highlights a need for HPs to fill in these gaps. Finally, the large number of videos geared towards the technical description of procedures illustrates the potential for official social media accounts to be used as teaching aids in the education of students and trainees, especially in contexts outside the classroom, such as a busy clinic. 

Our secondary aim was to explore attitudes towards and barriers to cervical cancer screening. The benefits of screening and vaccination were mentioned primarily in videos by HPs and rarely in videos by NHPs. This discrepancy could represent a shortcoming of the medical community in emphasising the reasoning behind medical interventions during visits. Additionally, this demonstrates the importance of using social media as a platform to disseminate credible information to viewers that bolsters their confidence in the medical system and educates them regarding health maintenance. 

Regarding barriers to screening, most videos that displayed themes of fear, pain, discomfort, distrust and lack of understanding were created by NHPs, demonstrating some of the sentiments patients feel regarding gynaecological interventions. It is important that the medical community is aware of these attitudes to anticipate patient concerns and counsel pre-emptively. This is especially true given these themes were not often addressed in videos created by HPs. Interestingly, the themes of racism/discrimination and socioeconomic barriers did not come up at all. This notable absence may reflect denial of bias on behalf of providers and/or hesitance of patient disclosure. However, it does not negate the possibility that these sentiments are discussed in less popular videos or on alternative platforms.  

Among HPs, the tone of the videos was predominantly positive compared with negative (52% vs 3%), while among NHPs it was more evenly distributed between positive and negative (43% vs 38%). This suggests that provider views of medical interventions may not always align with patient perceptions. 

There is a growing body of literature studying online health-related content in various fields and findings differ. A 2024 analysis of hysteroscopy-related TikTok videos identified most videos as being only partially accurate (43.8%) or uninformative (34.7%), with videos created by NHPs being more inaccurate or uninformative. Similarly, (videos created) by NHPs had lower mean understandability and actionability than those made by HPs.7 Another related study from 2023 exploring medication abortion related TikTok content found that 86.3% of videos that presented scientific claims were mostly accurate and that average understandability was high (86.3%) but average actionability was much lower (47.7%).8 The findings of this second study were more consistent with our findings. A 2024 study of TikTok content about epicondylitis found that videos made by medical doctors had higher content quality and reliability as compared with videos made by physiotherapists, reinforcing that providers should caution patients regarding treatment recommendations found online.9 The differences between the results of these studies demonstrate that depending on the topic, content available online may vary, further supporting the need for a consolidated effort on behalf of providers to share validated resources through professional or university-affiliated TikTok accounts.

Limitations of this study include the algorithmic nature of TikTok. While every attempt was made at selecting all the videos at one time using a predetermined number of views, some factors are difficult to control, such as time spent watching each video, which may influence the algorithm. This may have skewed the data in terms of which videos were prioritised for the viewer by the app. Another is the subjectivity of video reviewers. While each video was reviewed for specific themes by two independent reviewers and a third to clarify discrepancies, there was no way to control reviewers’ personal beliefs and experiences that may influence their analysis.  

Future directions include conducting surveys of patients or focus groups to directly inquire about personal use of TikTok to inform decision-making. Additionally, similar studies to this one could be performed involving a review of TikTok videos about HPV vaccination, pelvic examinations, excisional procedures and hysterectomies.  

In conclusion, this study illustrates the importance of open communication between provider and patient to address misconceptions and distrust, the value of patient testimonies online and the potential use of social media for disseminating credible medical information to both patients and trainees.