Digital Health Literacy and Proctology: Critically Evaluating Hemorrhoid Information Quality on Chinese TikTok (Douyin)

Highlights

• Physicians are the primary contributors of hemorrhoid-related information on Chinese TikTok, accounting for over 93% of high-quality content.
• A significant “engagement paradox” exists: low-quality, potentially misleading videos often achieve higher daily averages of likes and shares than high-quality, evidence-based content.
• Video length serves as a structural proxy for quality, with longer videos showing a significant positive correlation with Global Quality (GQS) and mDISCERN scores.
• Platform-wide improvements, including enhanced content moderation and incentives for authoritative sourcing, are critical for mitigating misinformation in proctology.

Background

Hemorrhoidal disease remains one of the most prevalent anorectal conditions globally, affecting approximately 39% to 50% of the adult population at some point in their lives. While historically a sensitive topic often discussed in private clinical settings, the rise of short-video platforms like TikTok (and its Chinese counterpart, Douyin) has transformed the landscape of patient education. For many patients, social media is now the first point of contact for health information, bypassing traditional gatekeepers such as general practitioners or specialists.

However, the democratization of health information on these platforms brings significant risks. The algorithm-driven nature of TikTok prioritizes engagement—likes, shares, and comments—often at the expense of scientific accuracy. In the context of hemorrhoids, where self-diagnosis and over-the-counter treatments are common, the spread of low-quality or commercially biased information can lead to delayed treatment, mismanagement of symptoms, or the masking of more serious conditions like colorectal cancer. This study provides a rigorous cross-sectional evaluation of the most popular hemorrhoid-related videos on Chinese TikTok to assess their clinical reliability and quality.

Key Content

Methodological Framework for Information Assessment

To evaluate the quality of the 87 most-liked hemorrhoid videos, the researchers utilized three validated tools that are standard in digital health literacy research:

• Global Quality Score (GQS): A 5-point scale used to evaluate the overall educational value and flow of information.
• Modified DISCERN (mDISCERN): A brief tool focusing on the reliability of the source, bias, and the clarity of references used in the health information.
• Journal of the American Medical Association (JAMA) Criteria: Used to assess the transparency of the video, including authorship, attribution of sources, disclosure of conflicts of interest, and currency of the information.

This multi-faceted approach allowed for a distinction between “popularity” (engagement metrics) and “quality” (scientific and educational rigor).

Source Analysis: Physicians vs. General Users

The study found that 74.71% (n = 65) of the analyzed videos were uploaded by certified physicians. This is a higher proportion of professional involvement than seen in previous studies of other medical topics on social media, suggesting that Chinese proctologists are actively engaging in digital outreach. Notably, physician-led content accounted for nearly all high-quality videos (93.34%). Conversely, low-quality content was primarily driven by general users and non-physician creators, who often lacked the clinical training to provide accurate diagnostic or therapeutic advice. The difference in quality between these groups reached a high level of statistical significance (p < 0.0001).

The Engagement Paradox and Algorithm Bias

One of the most striking findings was the inverse relationship between quality and engagement. While high-quality videos were significantly longer—suggesting a more thorough and nuanced discussion of symptoms and treatments—they did not necessarily correlate with higher popularity. In fact, low-quality videos recorded the highest levels of daily likes, comments, and shares. This suggests that the TikTok algorithm may favor sensationalized, overly simplified, or clickbait-style content that resonates with the “attention economy” rather than the structured, evidence-based explanations provided by certified medical professionals.

Structural Determinants of Quality

The study identified video length as a critical factor in information reliability. Spearman correlation analysis revealed that longer video durations were positively associated with higher GQS scores (r = 0.56, p < 0.001) and mDISCERN scores (r = 0.37, p < 0.001). For clinicians, this implies that the constraints of the "short-video" format (often 15–60 seconds) may be fundamentally at odds with the complexity required for medical education. High-quality content requires time to explain anatomical nuances, lifestyle modifications, and the indications for surgical intervention.

Expert Commentary

From a clinical standpoint, the prevalence of physician-led content on Chinese TikTok is a positive development. It suggests a professional move toward “narrative medicine” and public health advocacy. However, the study highlights a critical gap in the digital health ecosystem: the lack of a quality-based ranking system. When a patient searches for “hemorrhoids,” the platform prioritizes what is “viral,” not what is “accurate.”

Mechanistically, hemorrhoid management ranges from dietary fiber supplementation to advanced surgical procedures like Stapled Hemorrhoidopexy or Hemorrhoid Artery Ligation. Misinformation that over-promises “home cures” or fails to mention the red flags of colorectal malignancy (e.g., weight loss, change in bowel habits) poses a genuine public health threat. Experts suggest that platforms should implement “Verified Professional” tags more prominently and adjust algorithms to boost content that scores high on medical reliability indices. Furthermore, clinicians should proactively ask patients about their social media consumption during consultations to correct any misinformation acquired online.

Conclusion

While the overall quality of hemorrhoid-related videos on Chinese TikTok is moderate, the disparity between physician-produced high-quality content and user-produced low-quality content is vast. The study underscores that popularity on social media is a poor surrogate for medical accuracy. Future efforts should focus on encouraging physicians to leverage longer video formats for more comprehensive education and advocating for platform-level changes in content moderation. As social media continues to act as a primary source of health information, ensuring the scientific integrity of these platforms is no longer optional—it is a clinical necessity.

References

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• Loh NW, Gani F, Tan JS, et al. The reliability of health information on social media: A systematic review. J Med Internet Res. 2023;25:e45012.
• Almalki S, et al. Assessing the quality of health-related content on TikTok: A cross-sectional study of 10 common chronic conditions. BMC Public Health. 2024;24(1):104.