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Medication abortion on TikTok: misinformation or reliable resource?

2023; Elsevier BV; Volume: 228; Issue: 6 Linguagem: Inglês

10.1016/j.ajog.2023.01.023

1097-6868

Jenny Wu, Melissa Greene, Megan N. Happ, Esmé D. Trahair, Melissa N. Montoya, Jonas J. Swartz,

Health Literacy and Information Accessibility

TikTok, a short-form video-sharing application, is a popular platform used by 50.3% of the United States digital population.1Statista. Digital & trends: TikTok. Statista; 2022. Available at: https://www.statista.com/study/70013/tiktok/. Accessed September 7, 2022.Google Scholar Viral videos promoting non–US Food and Drug Administration (FDA)-approved regimens for inducing abortion have raised questions regarding the safety and accuracy of reproductive health information.2Brewster J, Arvanitis L, Pavilonis V, Wang M. Beware the ’new Google:’ TikTok’s search engine pumps toxic misinformation to its young Users. NewsGuard: NewsGuard, vol. 2022; 2022. Available at: https://www.newsguardtech.com/misinformation-monitor/september-2022/. Accessed October 3, 2022.Google Scholar We systematically analyzed and evaluated videos about medication abortion on TikTok. We evaluated the 100 most-viewed videos tagged under the hashtags #abortionpill, #medicalabortion, and #medicationabortion. We used the web-scraping application, Apify, to automatically download, extract, and compile information from the 100 most-viewed videos under each hashtag on September 25, 2022.3Sauerová M. TikTok Scraper. Apify; 2022. Available at: https://apify.com/sauermar/tiktok-scraper. Accessed September 7, 2022.Google Scholar Three independent reviewers (E.T., M.H., and M.G.) performed standardized video coding and a fourth reviewer (J.W.) served as arbitrator when differences arose. We a priori defined 18 descriptive data points about each video that could be collected by independent reviewers. Two standardized scales were also used, namely a modified 5-point DISCERN scale to evaluate the information quality and the Patient Education Materials Assessment Tool (PEMAT) to evaluate the understandability and actionability of each video.4Charnock 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: 105-111Crossref PubMed Google Scholar,5Shoemaker S.J. Wolf M.S. Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information.Patient Educ Couns. 2014; 96: 395-403Crossref PubMed Scopus (390) Google Scholar Coding was standardized over 2 sessions involving all reviewers who jointly agreed upon data points and scoring and who were trained through group-practice coding of 10 videos. Duke University Medical Center’s Institutional Review Board deemed this study to be nonhuman subject research. The top 100 videos about medication abortion on TikTok had a total of 12.1 million views, 1.8 million likes, and averaged 57 seconds in length. Eighteen videos were excluded because they were not in English language (n=10) or were duplicates (n=8). More than half (58%) of the videos provided medical education followed by personal experiences (13%), opinions (7%), and news-related information (7%) (Table). Abortion services accounts created 30% of the videos and often featured healthcare professionals who were the primary speakers in 28% of the videos. A majority (83%) had a pro-abortion stance. Almost half (45%) of the popular videos highlighted resources on how to obtain a medication abortion, and 14% specifically discussed the mechanism of action of medication abortion. Among educational videos, more than half discussed FDA-approved medications including mifepristone (n=30; 51.7%) and misoprostol (n=30; 51.7%), whereas only 4 videos discussed other methods of self-managed abortion.TableVideo characteristics of 100 TikTok videos evaluatedCharacteristic evaluatedN=100 (%)Country of originUnited States81 (81.0)Mexico9 (9.0)Europe4 (4.0)Canada2 (2.0)Other4 (4.0)Creator age≤21 y3 (3.0)≥21 y88 (88.0)Unspecified9 (9.0)Creator genderFemale78 (78.0)Male4 (4.0)Unspecified18 (18.0)Healthcare professionalYes28 (28.0) MD11 (11.0) RN5 (5.0) Midwife5 (5.0) Other7 (7.0)No or unspecified72 (72.0)Abortion services accountYes30 (30.0) Carafem10 (10.0) Safe2choose9 (9.0) Hey Jane3 (3.0) Planned Parenthood1 (1.0) Other7 (7.0)No72 (72.0)Abortion StancePro-abortion83 (83.0)Anti-abortion4 (4.0)Neutral4 (4.0)Mixed or ambiguous9 (9.0)Primary type of videoMedical education58 (58.0)Personal experience13 (13.0)Creator opinion7 (7.0)News7 (7.0)Humor6 (6.0)Political4 (4.0)Other5 (5.0)Medications discussedMifepristone35 (35.0)Misoprostol30 (30.0)Other5 (5.0) Methotrexate2 (2.0) Mugwort tea1 (1.0) Vitamin C1 (1.0) Alcohol1 (1.0)Compelling factorsTrustworthy source56Compelling story56Length of video44Audiovisual supplements41Catchy music40Humor14Modified DISCERNMean, 2.8; median, 3; IQR, 2–4PEMAT A/VUnderstandabilityMean, 88.1%; median, 87.5%; IQR, 87.5%–100%ActionabilityMean, 47.7%; median, 33.3%; IQR, 0%–100%Selective descriptive characteristics of TikTok videos collected through standardized coding performed by 2 independent reviewers per video.IQR, interquartile range; MD, medical doctor; PEMAT, Patient Education Materials Assessment Tool; RN, registered nurse.Wu. Abortion medication on TikTok. Am J Obstet Gynecol 2023. Open table in a new tab Selective descriptive characteristics of TikTok videos collected through standardized coding performed by 2 independent reviewers per video. IQR, interquartile range; MD, medical doctor; PEMAT, Patient Education Materials Assessment Tool; RN, registered nurse. Wu. Abortion medication on TikTok. Am J Obstet Gynecol 2023. Of the 51 videos that presented scientific claims, 86.3% were mostly accurate and 13.7% were mixed. Of the 65 videos that presented public health information, 89.2% were mostly accurate and 10.8% were mixed. No videos presented mostly inaccurate information. Video information quality averaged 2.8 out of 5 points on the DISCERN scale (median, 3; interquartile range [IQR], 2–4). Videos averaged 88.1% for understandability (median, 87.5%; IQR, 87.5%–100%) and 47.7% for actionability (median, 33.3%; IQR, 0%–100%) on the PEMAT. Almost 40% of young people search on TikTok before Google, yet 1 previous investigation concluded that up to 20% of videos contain misinformation.2Brewster J, Arvanitis L, Pavilonis V, Wang M. Beware the ’new Google:’ TikTok’s search engine pumps toxic misinformation to its young Users. NewsGuard: NewsGuard, vol. 2022; 2022. Available at: https://www.newsguardtech.com/misinformation-monitor/september-2022/. Accessed October 3, 2022.Google Scholar In contrast, we found that content related to medication abortion on TikTok was accurate and reliable. This may be attributable to TikTok’s internal policies for flagging inaccurate or unverified information as well as the significant number of videos by healthcare professionals and abortion organizations. Videos on medication abortion were of medium information quality based on DISCERN and scored highly in understandability on PEMAT. Our study suggests that engaging with TikTok allows the healthcare community to shape the accessible information about abortion. In a post-Roe era characterized by decreased access to reproductive health services, social media applications provide important opportunities to address knowledge gaps, combat abortion stigma, and empower patients.