中国四大社交媒体平台上吞咽困难人群进食指导短视频信息的质量、来源透明度、信息可靠性和领域覆盖：一项横断面研究

文献信息

中文摘要

背景： 标准化的进食指导对吞咽困难人群具有重要价值，有助于预防误吸、改善营养状况并提高生活质量。近年来，短视频平台已成为公众获取健康信息的重要途径，为吞咽困难人群提供了便捷的进食管理学习渠道。然而，网络健康信息质量差异较大，使患者难以有效区分可靠信息与潜在误区，可能对临床结局产生负面影响。
目的： 本研究旨在通过分析中国主流短视频平台上吞咽困难进食指导内容的质量、信息来源透明度、信息可靠性及相关领域覆盖情况，对该类内容进行系统评价。
方法： 本研究从中国四大主流短视频平台小红书、哔哩哔哩、抖音和快手检索并纳入278条吞咽困难进食指导短视频作为研究样本。两名专注于吞咽困难康复的独立康复治疗师采用源自吞咽困难人群进食指导相关临床指南和专家共识文件的10项标准，对视频内容的领域覆盖情况进行评价。我们使用美国医学会（JAMA）基准标准、全球质量评分（GQS）和改良DISCERN（mDISCERN）评分评估视频信息来源透明度、整体质量和信息可靠性。我们还比较了不同内容提供者和上传平台的视频数据。
结果： 根据视频上传者身份，视频被分为七类，包括四类医疗专业人员（康复医师、康复治疗师、康复护士及相关临床科室医疗专业人员）和三类非医疗专业人员（非营利组织、个人科普传播者和吞咽困难患者）。结果表明，吞咽困难人群进食指导视频的整体质量普遍较低（GQS中位数=2，IQR=2-3）。上传者身份的影响在不同评价维度上存在差异：医疗专业人员在JAMA评分（P<.001）和mDISCERN评分（P<.001）上均显著高于非医疗专业人员，尽管GQS评分的组间差异无统计学意义；康复护士在GQS维度表现最佳，相关临床科室医疗专业人员在mDISCERN维度得分最高，吞咽困难患者在JAMA维度得分最低。平台间差异也表现出维度依赖性：GQS评分差异最小，仅哔哩哔哩与快手之间存在统计学显著差异（校正P<.05，r=.376）；JAMA评分呈现中等差异，小红书、抖音和哔哩哔哩均显著优于快手（校正P<.0001，r=.387；校正P<.0001，r=.551；校正P<.05，r=.288）；mDISCERN评分差异最为明显（ε²=.503），抖音显著优于小红书、哔哩哔哩和快手（校正P<.0001，r=.771；校正P<.0001，r=.757；校正P<.0001，r=.595）。在领域覆盖方面，食物调整（77%）和吞咽姿势调整（52%）的覆盖率相对较高。相比之下，药物管理（4%）、营养管理（21%）和口腔护理（17%）等高风险领域存在严重供给缺口。
结论： 在中国当前主流短视频平台中，吞咽困难人群进食指导教育内容的整体质量仍需提高。该信息的可靠性取决于内容创作者的专业背景和平台生态。现有短视频目前难以为吞咽困难人群的安全决策和规范化自我管理提供充分支持。迫切需要实施整合专业 expertise、平台算法治理和多维质量评估的协同干预措施，以支持健康科普环境的规范化发展。

英文摘要

BACKGROUND: Standardized feeding guidance is valuable for people with dysphagia, helping prevent aspiration, improve nutritional status, and enhance quality of life. In recent years, short-video platforms have become a key avenue for the public to access health information, providing people with dysphagia with a convenient channel to learn about feeding management. However, the quality of online health information varies considerably, making it difficult for patients to effectively distinguish reliable information from potential misconceptions, which may negatively impact clinical outcomes.
OBJECTIVE: This study aims to systematically evaluate feeding guidance content for dysphagia on mainstream Chinese short-video platforms by analyzing its quality, the transparency of its information sources, the reliability of the information, and its coverage of relevant domains.
METHOD: This study retrieved and included 278 short videos on feeding guidance for dysphagia as research samples from four major Chinese mainstream short video platforms: Rednote, Bilibili, Douyin, and Kwai. Two independent rehabilitation therapists specializing in dysphagia rehabilitation evaluated the domain coverage of video content using 10 criteria derived from relevant clinical guidelines and expert consensus documents on feeding guidance for people with dysphagia. We assessed the transparency of the video's information sources, overall quality, and information reliability using the Journal of the American Medical Association (JAMA) Benchmark Criteria, the Global Quality Score (GQS), and the modified DISCERN (mDISCERN) Score. We also compared video data from different content providers and upload platforms.
RESULTS: Based on the identity of the video uploader, videos were classified into seven categories, comprising four categories of healthcare professionals (physiatrists, rehabilitation therapists, rehabilitation nurses, and healthcare professionals in related clinical departments) and three categories of non-healthcare professionals (non-profit organizations, individual science communicators, and people with dysphagia). The results indicated that the overall quality of feeding guidance videos for people with dysphagia was generally low (GQS median = 2, IQR = 2-3). The impact of uploader identity varied across assessment dimensions: healthcare professionals scored significantly higher than non-healthcare professionals on both the JAMA score (P < .001) and the mDISCERN score (P < .001), although the inter-group difference in the GQS score was not statistically significant; rehabilitation nurses performed best on the GQS dimension, healthcare professionals in related clinical departments achieved the highest scores on the mDISCERN dimension, and people with dysphagia scored the lowest on the JAMA dimension. Differences among platforms also exhibit dimensionality dependence: the GQS scores showed minimal variation, with only Bilibili and Kwai exhibiting a statistically significant difference (adjusted P < .05, r = .376); the JAMA scores demonstrated moderate variation, with Rednote, Douyin, and Bilibili all significantly outperforming Kwai (adjusted P < .0001, r = .387; adjusted P < .0001, r = .551; adjusted P < .05, r = .288); the mDISCERN scores showed the most pronounced differences (ε 2 = .503), with Douyin significantly surpassing Rednote, Bilibili, and Kwai (adjusted P < .0001, r = .771; adjusted P < .0001, r = .757; adjusted P < .0001, r = .595). In terms of domain coverage, food adjustment (77%) and swallowing posture adjustment (52%) had relatively high coverage rates. In contrast, high-risk domains such as medication management (4%), nutritional management (21%), and oral care (17%) exhibited severe supply gaps.
CONCLUSION: Among current mainstream short-video platforms in China, the overall quality of educational content on feeding guidance for people with dysphagia still requires improvement. The reliability of this information depends on both content creators' professional backgrounds and platform ecosystems. The existing short videos currently lack sufficient support for safe decision-making and standardized self-management among people with dysphagia. There is an urgent need to implement coordinated interventions that incorporate professional expertise, platform algorithm governance, and multidimensional quality assessments to support the standardized development of a health science communication environment.